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Jacob Boucher
NPI 1619501442 · on the registry since 2020 · sole proprietor
Practice
- Address
- 1235 Dakota Dr Ste L
Grafton, WI 53024 - Phone
- (262) 376-2085
- Clinicians at this address
- 5
Registry record
- Primary taxonomy
- 2251X0800X
2251X0800X
- Licence states on file
- WI
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-03-27
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Wisconsin