Katelyn Nicole Bouckaert, LLMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6851116233 Issued in MI

Practice address

1009 Washington Ave
Bay City, MI 48708-5705

Phone

(989) 928-3566

Fax

(989) 391-9596

NPI assigned

May 9, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1487390886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 WASHINTON AVE",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487085175",
            "telephone_number": "989-928-3566",
            "fax_number": "989-391-9596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 WASHINGTON AVE",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487085705",
            "telephone_number": "989-928-3566",
            "fax_number": "989-391-9596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 N Shiawassee St",
            "address_purpose": "LOCATION",
            "city": "Corunna",
            "state": "MI",
            "postal_code": "488171444",
            "country_code": "US",
            "telephone_number": "989-928-3566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUCKAERT",
        "first_name": "KATELYN",
        "middle_name": "NICOLE",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-09",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851116233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Essexville",
            "affiliation": "N",
            "address_1": "863 N Pine Rd",
            "city": "Essexville",
            "state": "MI",
            "country_code": "US",
            "postal_code": "487322159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lynnen Bostic
• Terri Botello
• Julie Kathryn Botimer, LAC, DIPL. O.M.
• Lori Lynn Boucard, RN
• Amanda Lynn Bouchard
• Michael Donald Bouckaert, RPH.
• Ashley Christine Boudreau, REGISTERED NURSE
• Jill Bourcier-Schultz
• Angela Marti Bourdlaies
• Christine Boven

• Clinical Social Worker in Bay City, MI
• Providers in Bay City, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.