MEDICARE: THERESA BOZIC LICSW

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	1041C0700X	Clinical Social Worker	15340	MN

General Provider Information

NPI Number	:	1669692232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA BOZIC LICSW

Provider Business Mailing Address
First Line	:	1801 AMERICAN BLVD E STE 8
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-1230
Country	:	US
Telephone Number	:	952-767-2267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 AMERICAN BLVD E STE 8
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55425-1230
Country	:	US
Telephone Number	:	952-767-2267
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	05/13/2020

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Directions to “ THERESA BOZIC LICSW” Practice Location

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