Healthcare Provider Details

I. General information

NPI: 1306765110
Provider Name (Legal Business Name): COURTNEY BOUDREAUX JOHNSON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY ANNE BOUDREAUX

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

240 N HIGHLAND AVE NE UNIT 3527
ATLANTA GA
30307-5620
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-4411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP013765
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: