Provider Demographics
NPI:1043567290
Name:BOUDREAU, JORDAN PAUL (PHD BCBA)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:PAUL
Last Name:BOUDREAU
Suffix:
Gender:M
Credentials:PHD BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39525 W 14 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1635
Mailing Address - Country:US
Mailing Address - Phone:231-497-0555
Mailing Address - Fax:855-605-7700
Practice Address - Street 1:39525 W 14 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1635
Practice Address - Country:US
Practice Address - Phone:231-497-0555
Practice Address - Fax:855-605-7700
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst