MEDICARE: JILL BOSWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1487084836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL BOSWELL

Provider Business Mailing Address
First Line	:	1460 NW VIVION RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4555
Country	:	US
Telephone Number	:	816-853-0946
Fax Number	:	816-396-8809

Provider Business Practice Location Address
First Line	:	1460 NW VIVION RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4555
Country	:	US
Telephone Number	:	816-853-0946
Fax Number	:	816-396-8809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	11/05/2020

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Directions to “ JILL BOSWELL ” Practice Location

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