Provider Demographics
NPI:1023404134
Name:BOSMA, RACHELLE GRACE (LMSW)
Entity type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:GRACE
Last Name:BOSMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 MARTIN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3543
Mailing Address - Country:US
Mailing Address - Phone:505-927-9672
Mailing Address - Fax:
Practice Address - Street 1:1131 IONIA AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1020
Practice Address - Country:US
Practice Address - Phone:616-259-7900
Practice Address - Fax:269-381-3810
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010985921041C0700X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251K00000XAgenciesPublic Health or Welfare