Individual
CERISE ELISE BOUCHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CLC
Contact information
Practice address
1733 BROOK PARK DR, LEXINGTON, KY 40515-1306
(859) 576-1062
Mailing address
1733 BROOK PARK DR, LEXINGTON, KY 40515-1306
(859) 576-1062
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
201197964
KY
Other
Enumeration date
01/26/2011
Last updated
06/14/2022
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