| Doctor Name: | GINA BOSCO |
| NPI Number: | 1104802230 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | LCSW1034 |
| Business Practice Address: | 2300 Overland Ave Burley, ID - 833182932 |
| Business Phone Number: | 2087328565 |
| Business Fax Number: | 2087328566 |
| Mailing Address: | Po Box 462, BURLEY |
| State: | ID |
| Postal Code: | 833180462 |
| Phone Number: | 2086703900 |
| Fax Number: | 2087328566 |
| NPI Enumeration Date: | 12/20/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW1034 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |