MEDICARE: JENNIFER LINNELL BOUCHET LCSW

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
1	1041C0700X	Clinical Social Worker	09923931	CO

General Provider Information

NPI Number	:	1689198962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LINNELL BOUCHET LCSW

Provider Business Mailing Address
First Line	:	978 EUCLID AVE
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-1839
Country	:	US
Telephone Number	:	970-963-3350
Fax Number	:	970-963-2958

Provider Business Practice Location Address
First Line	:	978 EUCLID AVE
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-1839
Country	:	US
Telephone Number	:	970-963-3350
Fax Number	:	970-963-2958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	07/21/2022

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