Organization
JAMIE J. BOUDREAU, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMIE J. BOUDREAU M.A., LCPC (PRESIDENT)
(815) 933-4072
Entity
Organization
Contact information
Practice address
183 E NORTH ST, BRADLEY, IL 60915-1268
(815) 933-4072
(815) 933-5564
Mailing address
183 E NORTH ST, BRADLEY, IL 60915-1268
(815) 933-4072
(815) 933-5564
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004623038
BC/BS OF ILLINOIS
IL
Enumeration date
09/05/2007
Last updated
09/05/2007
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