Provider Demographics
NPI:1700162609
Name:BOUDET, ASHLEY NICOLE (ND)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:NICOLE
Last Name:BOUDET
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 SW WILSHIRE ST
Mailing Address - Street 2:SUITE 190-D
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5035
Mailing Address - Country:US
Mailing Address - Phone:503-484-8647
Mailing Address - Fax:503-297-3827
Practice Address - Street 1:9900 SW WILSHIRE ST
Practice Address - Street 2:SUITE 190-D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5035
Practice Address - Country:US
Practice Address - Phone:503-484-8647
Practice Address - Fax:503-297-3827
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1861175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath