Provider Demographics
NPI:1063987469
Name:THE BOSS CLINIC LLC
Entity type:Organization
Organization Name:THE BOSS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BOSSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND, MS, CCC-SLP
Authorized Official - Phone:503-880-0391
Mailing Address - Street 1:2050 BEAVERCREEK RD
Mailing Address - Street 2:STE 101 PMB 423
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4301
Mailing Address - Country:US
Mailing Address - Phone:503-880-0391
Mailing Address - Fax:
Practice Address - Street 1:19142 S MOLALLA AVE STE A
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-7166
Practice Address - Country:US
Practice Address - Phone:503-383-1252
Practice Address - Fax:833-802-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty