| Organization Name: | JAMIE J. BOUDREAU, LTD |
| NPI Number: | 1548454382 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMIE J. BOUDREAU (PRESIDENT) |
| Mailing Address: | 183 E North St Bradley |
| State: | IL US |
| Postal Code: | 609151268 |
| Phone Number: | 8159334072 |
| Fax Number: | 8159335564 |
| NPI Enumeration Date: | 09/05/2007 |
| NPI Last Update Date: | 09/05/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |