Provider Demographics
NPI:1467700948
Name:BOSHANS, MELISSA A (MED)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BOSHANS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 N RIDGEWAY AVE
Mailing Address - Street 2:3N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1119
Mailing Address - Country:US
Mailing Address - Phone:773-876-4090
Mailing Address - Fax:
Practice Address - Street 1:2627 N RIDGEWAY AVE
Practice Address - Street 2:3N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1119
Practice Address - Country:US
Practice Address - Phone:773-876-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist