| Doctor Name: | JORDAN LYNN BOUCHER |
| NPI Number: | 1215310669 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD |
| License Number: | DI 60543717 |
| Business Practice Address: | 201 160th St S Ste 301 Spanaway, WA - 983878508 |
| Business Phone Number: | 2535314100 |
| Business Fax Number: | |
| Mailing Address: | 790 Remington Blvd, BOLINGBROOK |
| State: | IL |
| Postal Code: | 604404909 |
| Phone Number: | 6302962223 |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2015 |
| NPI Last Update Date: | 03/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | DI 60543717 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |