Provider Demographics
NPI:1598352601
Name:BOSEN, ELIZABETH (MSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BOSEN
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 1:835 E 4800 S STE 220
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5533
Mailing Address - Country:US
Mailing Address - Phone:801-262-5418
Mailing Address - Fax:
Practice Address - Street 1:835 E 4800 S STE 220
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5533
Practice Address - Country:US
Practice Address - Phone:801-262-5418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker