Individual
MS. MARY ANNE BOUDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3900 E VALLEY RD, SUITE 100, RENTON, WA 98057-4954
(425) 251-0698
(425) 251-8974
Mailing address
3900 E VALLEY RD, SUITE 100, RENTON, WA 98057-4954
(425) 251-0698
(425) 251-8974
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1051
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1051
LICENSE
WA
01
—
G8881323
MEDICARE PTAN
WA
Enumeration date
10/14/2006
Last updated
03/20/2016
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