Provider Demographics
NPI:1215109657
Name:BOSMAN, EVELYN (MSW)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:BOSMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:H
Other - Last Name:BOSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LMFT
Mailing Address - Street 1:120 S FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:616-842-9198
Mailing Address - Fax:
Practice Address - Street 1:120 S FIFTH ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417
Practice Address - Country:US
Practice Address - Phone:616-842-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801032838104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008976750OtherBLUE CROSS PIN