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Search › Arizona › 1041C0700X

Jacqueline Bohanske, LCSW

NPI 1922151992 · on the registry since 2007 · sole proprietor

Practice

Address
4050 E Greenway Rd
Suite 2
Phoenix, AZ 85032
Phone
(602) 867-4064
Fax
(602) 867-1827
Organisation at this address
Agave Healthcare Llc
Shining New Light Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
2

Registry record

Primary taxonomy
1041C0700X
1041C0700X
Licence states on file
AZ
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2019-12-18

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Arizona