Healthcare Provider Details

I. General information

NPI: 1689198962
Provider Name (Legal Business Name): JENNIFER LINNELL BOUCHET LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LINNELL BOUCHET LCSW

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 EUCLID AVE
CARBONDALE CO
81623-1839
US

IV. Provider business mailing address

978 EUCLID AVE
CARBONDALE CO
81623-1839
US

V. Phone/Fax

Practice location:
  • Phone: 970-963-3350
  • Fax: 970-963-2958
Mailing address:
  • Phone: 970-963-3350
  • Fax: 970-963-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09923931
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: