JORDAN LYNN BOUCHER (NPI# 1215310669) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215310669 |
| Entity Type | Individual |
| Full Name | JORDAN LYNN BOUCHER |
| Credential | RD |
| Practice Address |
110 Liberty St Ste 2a Brockton MA 02301-5674 |
| Mailing Address |
110 Liberty St Brockton MA 02301-5674 |
| Practice Telephone | 5088940766 |
| Practice Fax Number | 5085650097 |
| Mailing Telephone | 5088940400 |
| Mailing Fax Number | 5088940628 |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2020-05-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | DI 60543717 | WA | Dietary & Nutritional Service Providers |
| Street Address |
110 LIBERTY ST STE 2A |
| City | BROCKTON |
| State | MA |
| Zip Code | 02301-5674 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023533213 | Inna Wegner | Physician Assistant | 110 Liberty St Ste 2a, Brockton, MA 02301-5674 | 2017-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807110 | Jenny Vulpis | Recreation Therapist | 940 Belmont St (br 135), Brockton, MA 02301 | 2020-10-01 |
| 1205444924 | Caroline Storey | Counselor | Men's Addiction Treatment Center, 10 Meadowbrook Road, Brockton, MA 02301 | 2020-07-20 |
| 1013546852 | Nuria Dos Santos Veiga | Occupational Therapist | 73 Denton St, Brockton, MA 02301 | 2020-04-03 |
| 1679113930 | Laura Ann Brondyk II | Counselor | 10 Christys Dr, Brockton, MA 02301 | 2020-01-14 |
| 1437796521 | Andrea Lopes | Developmental Therapist | 7 Goddard Road, Brockton, MA 02301 | 2019-12-08 |
| 1518420124 | Diligencehealthcare | Psychiatry & Neurology | 30-40 Westpark Street, Brockton, MA 02301 | 2019-04-10 |
| 1124530373 | Rachel Theys | Behavioral Analyst | 130 Liberty St Ste 13a, Brockton, MA 02301 | 2017-10-27 |
| 1689193369 | Anderson D Delgado | Behavior Technician | 11 Packard Way, Brockton, MA 02301 | 2017-09-14 |
| 1811415326 | Francesca Lavecchia | Clinical Neuropsychologist | Brockto Area Multi Service, Inc. 10 Christy Dr., Brockton, MA 02301 | 2017-09-05 |
| 1831615343 | Donna Marie Dugan | Counselor | South Bay Community Services, 340 Main Street - Suite 818, Worcester, MA 02301 | 2017-08-16 |
| Find all providers in zip 02301 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487820080 | Patricia Ann Bebo | Dietitian, Registered | 54 Rutland Sq, Suite 2, Brockton, MA 02301-6825 | 2008-05-02 |
| 1902404981 | Sara Louise Borrello | Dietitian, Registered | 110 Liberty St, Brockton, MA 02301-5674 | 2020-10-13 |
| 1497319404 | Kathryn Lyons Egan | Dietitian, Registered | 940 Belmont St, Brockton, MA 02301-5596 | 2019-04-24 |
| 1952883274 | Sarah Federoff | Dietitian, Registered | 63 Main St, Brockton, MA 02301-4042 | 2018-09-04 |
| 1437699394 | Linda Bang Le | Dietitian, Registered | 63 Main St, Brockton, MA 02301-4042 | 2017-02-27 |
| 1649716895 | Genevieve Hicks | Dietitian, Registered | 63 Main St, Brockton, MA 02301-4042 | 2017-01-12 |
| 1932643863 | Kathryn Morin | Dietitian, Registered | 680 Centre St, Brockton Hospital, Dietitians Office, Brockton, MA 02302-3308 | 2016-12-12 |
| 1083156392 | Jonathan Zangwill | Dietitian, Registered | 680 Centre St, Signature Healthcare Brockton Hospital - Food/nutrition, Brockton, MA 02302-3308 | 2016-11-17 |
| 1831553981 | Amanda Good Heintzelman | Dietitian, Registered | 940 Belmont St, Brockton, MA 02301-5596 | 2016-04-05 |
| 1558721506 | Bethany Lusk | Dietitian, Registered | 189 Quincy St, Brockton, MA 02302-2967 | 2016-03-03 |
| Find all providers in BROCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.