Basic Information
| Provider Information | |||||||||
| NPI: | 1235312513 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOUCHER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A., LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6712 KIMBALL DR | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538582224 | ||||||||
| FaxNumber: | 2538582254 | ||||||||
| Practice Location | |||||||||
| Address1: | 6712 KIMBALL DR | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538582224 | ||||||||
| FaxNumber: | 2538582254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2007 | ||||||||
| LastUpdateDate: | 03/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LF60123453 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.