Healthcare Provider Details

I. General information

NPI: 1336063809
Provider Name (Legal Business Name): MIQUELA JO BUZZARD ED.S, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EDUCATION LN
POINT PLEASANT WV
25550-1152
US

IV. Provider business mailing address

1 EDUCATION LN
POINT PLEASANT WV
25550-1152
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-7570
  • Fax:
Mailing address:
  • Phone: 304-645-7570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberR5A151700293
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: