Provider Demographics
NPI:1487684684
Name:BOUSQUET, PATRICIA ANN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:BOUSQUET
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:STINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:42305 CADIZ DENNISON RD
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-9508
Mailing Address - Country:US
Mailing Address - Phone:740-942-4532
Mailing Address - Fax:
Practice Address - Street 1:VA PRIMARY CARE CLINIC
Practice Address - Street 2:103 PLAZA DRIVE, SUITE A
Practice Address - City:ST.CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:42950
Practice Address - Country:US
Practice Address - Phone:740-695-9321
Practice Address - Fax:740-695-6212
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00045571041C0700X
MELCS-001012401041C0700X
PASW1235041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW05931Medicare ID - Type Unspecified