Provider Demographics
NPI:1851080642
Name:BOUCHARD, CYNTHIA (LSWAIC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17330 135TH AVE NE STE 2B
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8522
Mailing Address - Country:US
Mailing Address - Phone:206-465-2826
Mailing Address - Fax:844-837-1339
Practice Address - Street 1:17330 135TH AVE NE STE 2B
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8522
Practice Address - Country:US
Practice Address - Phone:206-465-2826
Practice Address - Fax:844-837-1339
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC614349621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical