Healthcare Provider Details

I. General information

NPI: 1063987469
Provider Name (Legal Business Name): THE BOSS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19142 S MOLALLA AVE STE A
OREGON CITY OR
97045-7166
US

IV. Provider business mailing address

2050 BEAVERCREEK RD STE 101 PMB 423
OREGON CITY OR
97045-4301
US

V. Phone/Fax

Practice location:
  • Phone: 503-383-1252
  • Fax: 833-802-1444
Mailing address:
  • Phone: 503-880-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA ANNE BOSSERMAN
Title or Position: OWNER
Credential: ND, MS, CCC-SLP
Phone: 503-880-0391