John Bourque, L.B.S.W.

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6802060309 Issued in MI

Practice address

35000 Van Born Rd
Wayne, MI 48184-2458

Phone

(734) 722-1000

Fax

(734) 722-0368

NPI assigned

Jan 6, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• David John Bourque Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420502400000",
    "number": "1477941011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34807 PHYLLIS ST",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481842422",
            "telephone_number": "734-722-1000",
            "fax_number": "734-722-0368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35000 VAN BORN RD",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481842458",
            "telephone_number": "734-722-1000",
            "fax_number": "734-722-0368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURQUE",
        "first_name": "JOHN",
        "credential": "L.B.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-06",
        "last_updated": "2015-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6802060309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAVID",
            "last_name": "BOURQUE",
            "middle_name": "JOHN",
            "credential": "L.B.S.W.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Franklin Carl Bosworth III, PHARMD
• Daniel Bota, MD
• Alec Justin Botros
• Ashley Bouchard
• Brenda A Boudreaux, MSW LMSW
• Lorraine Bowman, LBSW QIDP
• Elka Boyd
• Charles Boykins III
• Juanita Bradley, LBSW
• Elliott Scott Brannon, MD

• Social Worker in Wayne, MI
• Providers in Wayne, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.