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NPI Code Detail

MEDICARE: MRS. JULIE MARIE BOUDREAU LMSW

MEDICARE: MRS. JULIE MARIE BOUDREAU LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801089512MI

General Provider Information

NPI Number : 1487837902
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIE MARIE BOUDREAU LMSW
Provider Business Mailing Address
First Line : 200 W SPRING ST
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-4661
Country : US
Telephone Number : 906-225-1181
Fax Number : 906-225-7203
Provider Business Practice Location Address
First Line : 200 W SPRING ST
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-4661
Country : US
Telephone Number : 906-225-1181
Fax Number : 906-225-7203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2007
Last Update Date : 04/17/2017

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