Provider Demographics
NPI:1811229594
Name:BOUCHARD, DAWN WRAY (CD(DONA))
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:WRAY
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29614 67TH AVE CT S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580
Mailing Address - Country:US
Mailing Address - Phone:253-905-5354
Mailing Address - Fax:
Practice Address - Street 1:29614 67TH AVE CT S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580
Practice Address - Country:US
Practice Address - Phone:253-905-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist