Doctor Name: | JESSICA L BOSECKER |
NPI Number: | 1437513736 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MHCA |
License Number: | 88000057A |
Business Practice Address: | 14 Trafalgar Sq Trafalgar, IN - 461819515 |
Business Phone Number: | 3174129190 |
Business Fax Number: | 3178782302 |
Mailing Address: | 14 Trafalgar Sq, TRAFALGAR |
State: | IN |
Postal Code: | 461819515 |
Phone Number: | 3174129190 |
Fax Number: | 3178782302 |
NPI Enumeration Date: | 04/12/2016 |
NPI Last Update Date: | 04/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 88000057A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |