Provider Demographics
NPI:1073971263
Name:BOUCHER, DANIELLE M (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SCHOOL ST UNIT 12
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4659
Mailing Address - Country:US
Mailing Address - Phone:978-399-8719
Mailing Address - Fax:
Practice Address - Street 1:7 BOYDS LN
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2829
Practice Address - Country:US
Practice Address - Phone:978-761-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77409235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist