Individual
GINA BOSCO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2300 OVERLAND AVE, BURLEY, ID 83318-2932
(208) 732-8565
(208) 732-8566
Mailing address
PO BOX 462, BURLEY, ID 83318-0462
(208) 670-3900
(208) 732-8566
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW1034
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00001001764
BLUESHIELD OF ID
ID
01
—
L5550
BLUECROSS OF ID
ID
Enumeration date
12/20/2005
Last updated
07/08/2007
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