Provider Demographics
NPI:1174667489
Name:BOULDIN, GRAHAM (MSW)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:
Last Name:BOULDIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 KAEN RD
Mailing Address - Street 2:SUITE 367
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4035
Mailing Address - Country:US
Mailing Address - Phone:503-742-5335
Mailing Address - Fax:503-742-5304
Practice Address - Street 1:2051 KAEN RD
Practice Address - Street 2:SUITE 367
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4035
Practice Address - Country:US
Practice Address - Phone:503-742-5335
Practice Address - Fax:503-742-5304
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker