1689198962 NPI number — JENNIFER LINNELL BOUCHET LCSW

Table of content: JENNIFER LINNELL BOUCHET LCSW (NPI 1689198962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689198962 NPI number — JENNIFER LINNELL BOUCHET LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOUCHET
Provider First Name:
JENNIFER
Provider Middle Name:
LINNELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOUCHET
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LINNELL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689198962
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:
978 EUCLID AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81623-1839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-963-3350
Provider Business Mailing Address Fax Number:
970-963-2958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
978 EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81623-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-963-3350
Provider Business Practice Location Address Fax Number:
970-963-2958
Provider Enumeration Date:
07/28/2017

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: 1041C0700X , with the licence number:  09923931 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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