Provider Demographics
NPI:1619751609
Name:BOSSCHER, JAMES ANDREW (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDREW
Last Name:BOSSCHER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 COVELL AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2613
Mailing Address - Country:US
Mailing Address - Phone:616-819-6209
Mailing Address - Fax:
Practice Address - Street 1:1417 COVELL AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-2613
Practice Address - Country:US
Practice Address - Phone:616-819-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011162011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical