Healthcare Provider Details

I. General information

NPI: 1275456212
Provider Name (Legal Business Name): ANDREA R BOSNJAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 N PALMYRA RD
CANFIELD OH
44406-9709
US

IV. Provider business mailing address

1363 MEADOWOOD CIR
POLAND OH
44514-3292
US

V. Phone/Fax

Practice location:
  • Phone: 330-519-7021
  • Fax:
Mailing address:
  • Phone: 330-519-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS0025098
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: