Provider Demographics
NPI:1245463009
Name:BOUCHER, REBECCA A (MS CC SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MS CC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-0248
Mailing Address - Country:US
Mailing Address - Phone:816-630-9200
Mailing Address - Fax:816-630-9203
Practice Address - Street 1:300 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-2102
Practice Address - Country:US
Practice Address - Phone:816-630-9200
Practice Address - Fax:816-630-9203
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009015693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist