Healthcare Provider Details

I. General information

NPI: 1487684684
Provider Name (Legal Business Name): PATRICIA ANN BOUSQUET MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA ANN STINSON MSW

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA PRIMARY CARE CLINIC 103 PLAZA DRIVE, SUITE A
ST.CLAIRSVILLE OH
42950
US

IV. Provider business mailing address

42305 CADIZ DENNISON RD
CADIZ OH
43907-9508
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-9321
  • Fax: 740-695-6212
Mailing address:
  • Phone: 740-942-4532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0004557
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS-00101240
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW123504
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: