Individual
DR. KENNETH R BOUCHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
6777 WEST MAPLE ROAD, OTOLARYNGOLOGY/AUDIOLOGY HENRY FORD W.BLOOMFILED HOSP, WEST BLOOMFIELD, MI 48322
(248) 925-8276
Mailing address
32411 BRIARCREST KNLS, FARMINGTON HILLS, MI 48334-1515
(248) 505-1689
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
1601000335
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1601000335
AUDIOLOGIST LICENSE STATE
MI
Enumeration date
01/16/2007
Last updated
10/22/2012
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