Provider Demographics
NPI:1528456126
Name:BOUDREAU, PEPPI
Entity type:Individual
Prefix:
First Name:PEPPI
Middle Name:
Last Name:BOUDREAU
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 1:3123 NW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6205
Mailing Address - Country:US
Mailing Address - Phone:405-604-0452
Mailing Address - Fax:405-604-0452
Practice Address - Street 1:3123 NW 39TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6205
Practice Address - Country:US
Practice Address - Phone:405-604-0452
Practice Address - Fax:405-604-0452
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health