Provider Demographics
NPI:1407618259
Name:BOSMA, LAUREL ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:ANN
Last Name:BOSMA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 NE SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3655
Mailing Address - Country:US
Mailing Address - Phone:703-269-8234
Mailing Address - Fax:
Practice Address - Street 1:18417 SE OAK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-4850
Practice Address - Country:US
Practice Address - Phone:971-727-8026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health