Individual
ALISA BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
4233 ISLAND PARK DR, WATERFORD, MI 48329-1916
(248) 468-6823
Mailing address
7111 DIXIE HWY STE 362, CLARKSTON, MI 48346-2077
(248) 468-6823
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
Other
Enumeration date
10/02/2021
Last updated
10/02/2021
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