Provider Demographics
NPI:1962938795
Name:BOSHAW, MARK (BS CADC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BOSHAW
Suffix:
Gender:M
Credentials:BS CADC
Other - Prefix:
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Mailing Address - Street 1:97 S 4TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-2168
Mailing Address - Country:US
Mailing Address - Phone:906-225-9699
Mailing Address - Fax:906-228-0505
Practice Address - Street 1:799 HOMBACH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1735
Practice Address - Country:US
Practice Address - Phone:906-643-0944
Practice Address - Fax:906-984-4400
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)