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General NPI Number Information
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NPI Number | 1700431277
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Entity Type | Individual
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Provider Name | NYCOLA ANN BOUCK MSW LISW-S
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Gender | Female
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 348 MAIN ST
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City | HURON
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State | OH
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Zip | 44839-1610
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Country | US
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Telephone | 419-359-0307
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Fax |
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Provider Business Mailing Address
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Address Line | 348 MAIN ST
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City | HURON
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State | OH
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Zip | 44839-1610
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Country | US
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Telephone | 419-359-0307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.0800023-SUPV
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License Number State | OH
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