MEDICARE: MARLIN D BOZONE L.P.C.

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
1	101YP2500X	Professional Counselor	199	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548295009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLIN D BOZONE L.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 4105
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-4105
Country	:	US
Telephone Number	:	866-907-1068
Fax Number	:	425-917-9141

Provider Business Practice Location Address
First Line	:	2250 S WOODWORTH LOOP STE 202
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-7457
Country	:	US
Telephone Number	:	907-761-5800
Fax Number	:	907-762-5801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	03/28/2019

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Directions to “ MARLIN D BOZONE L.P.C.” Practice Location

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