MEDICARE: MCKAYLA BOUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2022047471	MO

General Provider Information

NPI Number	:	1336971662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKAYLA BOUSE

Provider Business Mailing Address
First Line	:	550 W B ST FL 4
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-3537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2044 OAKTIMBER CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-6729
Country	:	US
Telephone Number	:	417-308-8705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	02/17/2026

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Directions to “ MCKAYLA BOUSE ” Practice Location

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