Provider Demographics
NPI:1104916469
Name:BOUDIN, HENRY M (PHD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:M
Last Name:BOUDIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 E VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4954
Mailing Address - Country:US
Mailing Address - Phone:425-251-0698
Mailing Address - Fax:425-251-8974
Practice Address - Street 1:3900 E VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4954
Practice Address - Country:US
Practice Address - Phone:425-251-0698
Practice Address - Fax:425-251-8974
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA1001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB06998Medicare ID - Type Unspecified