Provider Demographics
NPI:1255401287
Name:BOSHOVEN, ELIZABETH ANNE (LMSW ACSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:BOSHOVEN
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4403 CASCADE ROAD SE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-309-4553
Mailing Address - Fax:616-469-1078
Practice Address - Street 1:4403 CASCADE ROAD SE
Practice Address - Street 2:SUITE 7
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-309-4553
Practice Address - Fax:616-469-1078
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010875551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical