| Doctor Name: | NICOLE RENAE BOUCHER |
| NPI Number: | 1053530345 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | 771 |
| Business Practice Address: | 1702 University Dr S Fargo, ND - 581034940 |
| Business Phone Number: | 7013643300 |
| Business Fax Number: | 7013648906 |
| Mailing Address: | Po Box 6001, FARGO |
| State: | ND |
| Postal Code: | 581086001 |
| Phone Number: | 7013643300 |
| Fax Number: | 7013648906 |
| NPI Enumeration Date: | 04/25/2007 |
| NPI Last Update Date: | 01/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 771 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |