| Doctor Name: | RENATA RAYE BOSEK |
| NPI Number: | 1164788600 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 891 Belsly Blvd Moorhead, MN - 565605055 |
| Business Phone Number: | 3207625411 |
| Business Fax Number: | |
| Mailing Address: | 3120 1st St, STURGEON LAKE |
| State: | MN |
| Postal Code: | 557833874 |
| Phone Number: | 2182137199 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2012 |
| NPI Last Update Date: | 04/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |