Provider Demographics
NPI:1457025371
Name:BOSANKO, MARIA JOSE (SLP)
Entity Type:Individual
Prefix:
First Name:MARIA JOSE
Middle Name:
Last Name:BOSANKO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:JOSE
Other - Last Name:BOSANKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:6550 SEVENOAKS AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7324
Mailing Address - Country:US
Mailing Address - Phone:225-929-8600
Mailing Address - Fax:
Practice Address - Street 1:6550 SEVENOAKS AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7324
Practice Address - Country:US
Practice Address - Phone:225-929-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist