Healthcare Provider Details

I. General information

NPI: 1093926057
Provider Name (Legal Business Name): LAURIE BOSER MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27485 273RD ST
PIERZ MN
56364-1963
US

IV. Provider business mailing address

27485 273RD ST
PIERZ MN
56364-1963
US

V. Phone/Fax

Practice location:
  • Phone: 218-838-7770
  • Fax: 320-277-3060
Mailing address:
  • Phone: 218-838-7770
  • Fax: 320-277-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10693
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: