Provider Demographics
NPI:1285103549
Name:BOUCHER, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8642 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8218
Mailing Address - Country:US
Mailing Address - Phone:517-331-3460
Mailing Address - Fax:
Practice Address - Street 1:1345 MONROE AVE NW STE 140
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4609
Practice Address - Country:US
Practice Address - Phone:616-458-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator