Provider Demographics
NPI:1306402821
Name:BOUCHER, CHANTAL. MARIE (BAH, MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHANTAL.
Middle Name:MARIE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:BAH, MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 DURHAM PLACE.
Mailing Address - Street 2:
Mailing Address - City:WINDSOR.
Mailing Address - State:ONTARIO.
Mailing Address - Zip Code:N8W 3A3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 E. WASHINGTON ST.
Practice Address - Street 2:SUITE 100.
Practice Address - City:ANN ARBOR.
Practice Address - State:MI
Practice Address - Zip Code:48104-2057
Practice Address - Country:US
Practice Address - Phone:734-764-3471
Practice Address - Fax:734-764-8128
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program