Healthcare Provider Details

I. General information

NPI: 1407595655
Provider Name (Legal Business Name): MELISSA BOSART LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 E MAIN ST
COLUMBUS OH
43213-3298
US

IV. Provider business mailing address

4653 E MAIN ST
COLUMBUS OH
43213-3298
US

V. Phone/Fax

Practice location:
  • Phone: 614-729-9645
  • Fax:
Mailing address:
  • Phone: 614-729-9645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0029537
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: