Basic Information
| Provider Information | |||||||||
| NPI: | 1689792616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOUCHARD | ||||||||
| FirstName: | KATHIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH SCITUATE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028572120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016477138 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 WOODLAND DR | ||||||||
| Address2: | COVENTRY SKILLED NURSING AND REHAB | ||||||||
| City: | COVENTRY | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028166716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018262000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 11/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP00123 | RI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.