Provider Demographics
NPI:1275653610
Name:BOUCHARD, VALERIE A (PSYD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S WILKE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1534
Mailing Address - Country:US
Mailing Address - Phone:847-841-5110
Mailing Address - Fax:
Practice Address - Street 1:125 S WILKE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1534
Practice Address - Country:US
Practice Address - Phone:847-841-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005117103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL383591Medicare ID - Type UnspecifiedMEDICARE