1306402821 NPI number — DR. CHANTAL. MARIE BOUCHER B.A.H, M.A., PH.D.

Table of content: DR. CHANTAL. MARIE BOUCHER B.A.H, M.A., PH.D. (NPI 1306402821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306402821 NPI number — DR. CHANTAL. MARIE BOUCHER B.A.H, M.A., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOUCHER
Provider First Name:
CHANTAL.
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
B.A.H, M.A., PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306402821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1814 DURHAM PLACE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDSOR.
Provider Business Mailing Address State Name:
ONTARIO.
Provider Business Mailing Address Postal Code:
N8W 3A3
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 E. WASHINGTON ST.
Provider Second Line Business Practice Location Address:
SUITE 100.
Provider Business Practice Location Address City Name:
ANN ARBOR.
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48104-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-764-3471
Provider Business Practice Location Address Fax Number:
734-764-8128
Provider Enumeration Date:
05/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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