Healthcare Provider Details

I. General information

NPI: 1255401287
Provider Name (Legal Business Name): ELIZABETH ANNE BOSHOVEN LMSW ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 CASCADE ROAD SE SUITE 7
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

4403 CASCADE ROAD SE SUITE 7
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-309-4553
  • Fax: 616-469-1078
Mailing address:
  • Phone: 616-309-4553
  • Fax: 616-469-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: