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NPI Code Detail

MEDICARE: ELIZABETH BOSEN MSW

MEDICARE: ELIZABETH BOSEN MSW
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
11041C0700XClinical Social Worker12224250-3501UT

General Provider Information

NPI Number : 1598352601
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH BOSEN MSW
Provider Business Mailing Address
First Line : 4578 S HIGHLAND DR STE 320
Second Line :
City : MILLCREEK
State : UT
Zip : 84117-4214
Country : US
Telephone Number : 385-272-8906
Fax Number :
Provider Business Practice Location Address
First Line : 4578 S HIGHLAND DR STE 320
Second Line :
City : MILLCREEK
State : UT
Zip : 84117-4214
Country : US
Telephone Number : 385-272-8906
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2020
Last Update Date : 11/12/2024

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