Provider Demographics
NPI:1780035626
Name:BOULANGEE, ERICA (LAC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BOULANGEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S SPRING ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-2806
Mailing Address - Country:US
Mailing Address - Phone:970-274-8717
Mailing Address - Fax:
Practice Address - Street 1:300 S SPRING ST STE 203
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-2806
Practice Address - Country:US
Practice Address - Phone:970-274-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002202171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist