Provider Information for 1093110470
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RAINEY BOATENG LCSW
Sex: Female
NPI: 1093110470
Last Updated: 2014-10-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1093110470 | ||||||||
| Enumeration Date | 2014-10-28 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9425 S RIVERSIDE DR APT. 1636 SANDY, UT 84070-6511 United States Phone: 208-242-6325 | Fax: | ||||||||
| Primary Practice Address | 501 S CHIPETA WAY SALT LAKE CITY, UT 84108-1222 United States Phone: 801-583-2500 | Fax: | ||||||||
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