Provider Demographics
NPI:1740991322
Name:BOSQUEZ, WILLIAM MICHAEL
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:BOSQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W TYRELL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-1532
Mailing Address - Country:US
Mailing Address - Phone:248-935-5691
Mailing Address - Fax:
Practice Address - Street 1:724 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1900
Practice Address - Country:US
Practice Address - Phone:989-796-4555
Practice Address - Fax:989-285-1674
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511140211041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical