Individual
LORI MARIE BOUSHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
1407 SAINT ANDREW ST STE 100, LA CROSSE, WI 54603-2378
(608) 785-6266
Mailing address
W3002 WILDWOOD RD, GRANTON, WI 54436-9278
(715) 937-0773
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
9893-120
WI
Other
Enumeration date
02/08/2010
Last updated
02/08/2010
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