Provider Demographics
NPI:1215339387
Name:BAUSCHARD, LOUISE ANN X (LCSW)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:ANN
Last Name:BAUSCHARD
Suffix:X
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LOUISE
Other - Middle Name:ANN
Other - Last Name:BAUSCHARD
Other - Suffix:X
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:254 N 1ST AVE
Mailing Address - Street 2:# 105
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3003
Mailing Address - Country:US
Mailing Address - Phone:503-997-8041
Mailing Address - Fax:503-846-0709
Practice Address - Street 1:254 N 1ST AVE
Practice Address - Street 2:# 105
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3003
Practice Address - Country:US
Practice Address - Phone:503-997-8041
Practice Address - Fax:503-846-0709
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL2155SR252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency