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General NPI Number Information
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NPI Number | 1013222850
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Entity Type | Individual
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Provider Name | DONNA MERLE BOULETTE SLP
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Gender | Female
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 1950 LIVE OAK ST
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City | SAN ANGELO
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State | TX
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Zip | 76901-3944
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Country | US
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Telephone | 325-315-3146
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 LIVE OAK ST
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City | SAN ANGELO
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State | TX
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Zip | 76901-3944
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Country | US
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Telephone | 325-315-3146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 80195
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 103968
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License Number State | TX
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