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General NPI Number Information
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NPI Number | 1104639632
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Entity Type | Individual
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Provider Name | MARGARET LYNN BOULOS
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Gender | Female
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 999 ORONOQUE LN
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City | STRATFORD
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State | CT
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Zip | 06614-1379
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Country | US
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Telephone | 203-870-2022
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Fax | 203-386-1144
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Provider Business Mailing Address
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Address Line | 36 BROOKDALE AVE
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City | MILFORD
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State | CT
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Zip | 06460-5933
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Country | US
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Telephone | 561-310-3698
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2389
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License Number State | CT
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