Individual
JOHN BOURQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.B.S.W.
Contact information
Practice address
35000 VAN BORN RD, WAYNE, MI 48184-2458
(734) 722-1000
(734) 722-0368
Mailing address
34807 PHYLLIS ST, WAYNE, MI 48184-2422
(734) 722-1000
(734) 722-0368
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802060309
MI
Other
Enumeration date
01/06/2015
Last updated
01/06/2015
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