Individual
MIKAYLAH M BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8303 SW LOCUST ST, TIGARD, OR 97223-8816
(503) 645-3581
Mailing address
1718 SE ORIENT DR APT 3129, GRESHAM, OR 97080-5262
(971) 409-1832
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/15/2019
Last updated
10/15/2019
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