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Individual
KERRI N. BOUTELLE
Active
Individual
KERRI N. BOUTELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY21823
CA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY21823
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0491997
—
MT
01
—
1019785
PREFERRED ONE
MN
01
—
10387
ND MA
ND
01
—
123420
UCARE
MN
01
—
205A4BO
BCBS
MN
01
—
39136900
WI MA
WI
01
—
61-60634
MEDICA CHOICE & PRIMARY
MN
05
—
7777470
—
SD
01
—
839397
ARAZ
MN
05
—
923517500
—
MN
01
—
HP34903
HEALTHPARTNERS
MN
Enumeration date
06/22/2006
Last updated
07/22/2019
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