MEDICARE: JAMES ANDREW BOSSCHER LMSW

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	1041C0700X	Clinical Social Worker	6801116201	MI

General Provider Information

NPI Number	:	1619751609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ANDREW BOSSCHER LMSW

Provider Business Mailing Address
First Line	:	1417 COVELL AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-2613
Country	:	US
Telephone Number	:	616-819-6209
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 COVELL AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-2613
Country	:	US
Telephone Number	:	616-819-6209
Fax Number	:

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

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	08/22/2023

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