Provider Demographics
NPI:1487802542
Name:BOSLEY, ANISA RIVA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANISA
Middle Name:RIVA
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:ANISA
Other - Middle Name:RIVA
Other - Last Name:BUENTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 STEELE
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5883
Mailing Address - Country:US
Mailing Address - Phone:956-279-4405
Mailing Address - Fax:
Practice Address - Street 1:117 STEELE
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5883
Practice Address - Country:US
Practice Address - Phone:956-279-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103635235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist