Individual
MR. MISTY DAWN BOSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
101 S WASHINGTON ST, MARION, IN 46952-3867
(765) 662-9971
Mailing address
101 S WASHINGTON ST, MARION, IN 46952-3867
(765) 662-9971
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100125240A
—
IN
Enumeration date
06/05/2020
Last updated
06/05/2020
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