Individual
MRS. GERI LYNN BOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
113 LINCOLN WAY EAST, MISHAWAKA, IN 46544-2016
(574) 255-4976
(574) 255-1882
Mailing address
113 LINCOLN WAY EAST, MISHAWAKA, IN 46544-2016
(574) 255-4976
(574) 255-1882
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34003576A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000341297
ANTHEM
IN
05
—
200475040
—
IN
01
—
400556
MHN
IN
01
—
795201000
MAGELLAN
IN
Enumeration date
11/13/2006
Last updated
01/24/2020
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