| Doctor Name: | JOSCELYN BOUDREAU |
| NPI Number: | 1285095786 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 2973 |
| Business Practice Address: | 598 Lockhart Gulch Rd Scotts Valley, CA - 950663060 |
| Business Phone Number: | 8313254668 |
| Business Fax Number: | 4082494645 |
| Mailing Address: | 598 Lockhart Gulch Rd, SCOTTS VALLEY |
| State: | CA |
| Postal Code: | 950663060 |
| Phone Number: | 8313254668 |
| Fax Number: | 4082494645 |
| NPI Enumeration Date: | 03/10/2016 |
| NPI Last Update Date: | 03/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 2973 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |