Provider Demographics
NPI:1104133289
Name:JANICE WUNDERLE BOSLEY PHD LLC
Entity type:Organization
Organization Name:JANICE WUNDERLE BOSLEY PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:WUNDERLE
Authorized Official - Last Name:BOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:740-881-4394
Mailing Address - Street 1:5295 BAYPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9042
Mailing Address - Country:US
Mailing Address - Phone:740-881-4394
Mailing Address - Fax:740-881-1515
Practice Address - Street 1:4775 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4313
Practice Address - Country:US
Practice Address - Phone:740-881-4394
Practice Address - Fax:740-881-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3738103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty