Provider Demographics
NPI:1265248884
Name:BOUYEA, JAYLYNN
Entity type:Individual
Prefix:
First Name:JAYLYNN
Middle Name:
Last Name:BOUYEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-2616
Mailing Address - Country:US
Mailing Address - Phone:518-643-6484
Mailing Address - Fax:
Practice Address - Street 1:17 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972-2616
Practice Address - Country:US
Practice Address - Phone:518-643-6484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool