Individual
JESSICA BASS BOSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3415 YOUNGSTOWN DR, FAYETTEVILLE, NC 28303
(703) 447-0454
Mailing address
3415 YOUNGSTOWN DR, FAYETTEVILLE, NC 28303-4652
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
—
GA
103TS0200X
School Psychologist
—
NC
103TS0200X
School Psychologist
Primary
—
VA
Other
Enumeration date
11/21/2017
Last updated
11/21/2017
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