| Doctor Name: | JESSICA LOUISE BOUGIE |
| NPI Number: | 1467646117 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 5130 East Main Street Road, Suite 2 Batavia, NY - 140203496 |
| Business Phone Number: | 5853441421 |
| Business Fax Number: | 5853443047 |
| Mailing Address: | 60 Crittenden Blvd Apt 238, ROCHESTER |
| State: | NY |
| Postal Code: | 14620 |
| Phone Number: | 6038177098 |
| Fax Number: | |
| NPI Enumeration Date: | 09/05/2007 |
| NPI Last Update Date: | 09/07/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |