Individual
MRS. THERESA MARIE BOSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA,CCC-A
Contact information
Practice address
1425 MICHIGAN NE SUITE A, GRAND RAPIDS, MI 49503
(616) 459-4514
(616) 459-5001
Mailing address
1425 MICHIGAN NE SUITE A, GRAND RAPIDS EAR NOSE & THROAT, PC, GRAND RAPIDS, MI 49503
(616) 459-7749
(616) 459-5001
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1601000098
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
640D126260
BLUE SHIELD HEARING PROVI
MI
Enumeration date
04/26/2007
Last updated
08/19/2013
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