Provider Demographics
NPI:1437513736
Name:BOSECKER, JESSICA L (MHCA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:BOSECKER
Suffix:
Gender:F
Credentials:MHCA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 TRAFALGAR SQ
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181-9515
Mailing Address - Country:US
Mailing Address - Phone:317-412-9190
Mailing Address - Fax:317-878-2302
Practice Address - Street 1:14 TRAFALGAR SQ
Practice Address - Street 2:
Practice Address - City:TRAFALGAR
Practice Address - State:IN
Practice Address - Zip Code:46181-9515
Practice Address - Country:US
Practice Address - Phone:317-412-9190
Practice Address - Fax:317-878-2302
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000057A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health