Individual
KELLILYNN BOSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
150 S WALL ST, COOS BAY, OR 97420-3233
(541) 435-7200
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2099
(541) 267-5151
(541) 266-4554
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
149019376
IL
1041C0700X
Clinical Social Worker
Primary
L8472
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500779268
—
OR
Enumeration date
05/18/2017
Last updated
11/06/2025
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