Provider Demographics
NPI:1265528376
Name:BOSWORTH, MICHELLE QUENEAU (MS)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:QUENEAU
Last Name:BOSWORTH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:QUENEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 70368
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0120
Mailing Address - Country:US
Mailing Address - Phone:541-868-9746
Mailing Address - Fax:541-246-2353
Practice Address - Street 1:3355 RIVERBEND DR STE 210
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8800
Practice Address - Country:US
Practice Address - Phone:541-349-7600
Practice Address - Fax:541-686-8330
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS