Individual
HALEY BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2751 WARM SPRINGS RD, COLUMBUS, GA 31904-6858
(800) 356-4049
(941) 485-0519
Mailing address
5 REVERE DR STE 120, NORTHBROOK, IL 60062-8005
(800) 356-4049
(941) 485-0519
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-137225
GA
Other
Enumeration date
09/28/2020
Last updated
09/28/2020
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