Doctor Name: | KURTT RUSSELL BOUCHER |
NPI Number: | 1871750059 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | SLP |
License Number: | 7004843-4102 |
Business Practice Address: | 15 South 1000 East #25 Payson, UT - 846511600 |
Business Phone Number: | 8014655610 |
Business Fax Number: | 8014655615 |
Mailing Address: | 15 South 1000 East, #25 PAYSON |
State: | UT |
Postal Code: | 846511600 |
Phone Number: | 8014655610 |
Fax Number: | 8014655615 |
NPI Enumeration Date: | 05/16/2008 |
NPI Last Update Date: | 02/20/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 7004843-4102 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
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 |