Individual
JEREMY M BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
290 W EXCHANGE STREET, SUITE 101, PROVIDENCE, RI 02903
(401) 214-2330
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/08/2019
Last updated
08/08/2019
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