Provider Demographics
NPI:1689856817
Name:GOUCHER, JAYLE MARIE
Entity Type:Individual
Prefix:MRS
First Name:JAYLE
Middle Name:MARIE
Last Name:GOUCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3057 BRIW RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5321
Mailing Address - Country:US
Mailing Address - Phone:530-642-4818
Mailing Address - Fax:530-622-1543
Practice Address - Street 1:3057 BRIW RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5321
Practice Address - Country:US
Practice Address - Phone:530-642-4818
Practice Address - Fax:530-622-1543
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator