Provider Demographics
NPI:1922896232
Name:BOUCHER, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BOUCHER
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 1:201 N ILLINOIS ST STE 1600
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-4218
Mailing Address - Country:US
Mailing Address - Phone:317-593-1243
Mailing Address - Fax:
Practice Address - Street 1:201 N ILLINOIS ST STE 1600
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-4218
Practice Address - Country:US
Practice Address - Phone:317-593-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician