Provider Demographics
NPI:1659385458
Name:BOUCHARD, LOUISE J (SERVICE COORDINATOR)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:J
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1712
Mailing Address - Country:US
Mailing Address - Phone:401-438-9500
Mailing Address - Fax:
Practice Address - Street 1:667 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1712
Practice Address - Country:US
Practice Address - Phone:401-438-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2092OtherEI NHPRC
RI412296OtherEI BCHIP
RIES01788Medicaid
RI292177OtherEI BLUE CROSS
RI6400144OtherEI UHP