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NPI Code Detail

MEDICARE: JESSICA BOSAK LSW

MEDICARE: JESSICA BOSAK LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerSW133053PA

General Provider Information

NPI Number : 1528548849
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA BOSAK LSW
Provider Business Mailing Address
First Line : 1310 VALLEY VIEW BLVD
Second Line :
City : ALTOONA
State : PA
Zip : 16602-6080
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 705 12TH ST
Second Line :
City : ALTOONA
State : PA
Zip : 16602-2419
Country : US
Telephone Number : 814-944-9970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2018
Last Update Date : 08/16/2018

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Directions to “ JESSICA BOSAK LSW” Practice Location

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