Provider Demographics
NPI:1841716511
Name:BOUCHER, JUNE ELLEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUNE
Middle Name:ELLEN
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 N MILWAUKEE ST # 338
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8471
Mailing Address - Country:US
Mailing Address - Phone:208-519-6971
Mailing Address - Fax:208-963-3056
Practice Address - Street 1:1287 E DRUCKER ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4031
Practice Address - Country:US
Practice Address - Phone:208-571-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-35956104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker