Individual
DR. GILLIAN BOUDREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
364 DORSET ST, SUITE 212, SOUTH BURLINGTON, VT 05403-6270
(802) 658-9440
Mailing address
364 DORSET ST, SUITE 212, SOUTH BURLINGTON, VT 05403-6270
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
048.0072593
VT
103TS0200X
School Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12350163
CAQH
—
Enumeration date
09/11/2008
Last updated
05/14/2012
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