Healthcare Provider Details

I. General information

NPI: 1063183184
Provider Name (Legal Business Name): LAURA ELIZABETH BOSSERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S HOLLYWOOD ST
MEMPHIS TN
38112-4801
US

IV. Provider business mailing address

414 UNION ST STE 1100
NASHVILLE TN
37219-1718
US

V. Phone/Fax

Practice location:
  • Phone: 901-416-5300
  • Fax:
Mailing address:
  • Phone: 615-983-5318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6868
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: