Provider Demographics
NPI:1568297513
Name:BOUGHN, ZOE
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:BOUGHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-0223
Mailing Address - Country:US
Mailing Address - Phone:503-983-2963
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 223
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-0223
Practice Address - Country:US
Practice Address - Phone:503-983-2963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent