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General NPI Number Information
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NPI Number | 1295016582
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Entity Type | Individual
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Provider Name | PATRICIA ANN BOUDREAUX CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 714 93RD ST
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City | GALVESTON
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State | TX
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Zip | 77554-7186
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Country | US
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Telephone | 719-459-3670
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Fax |
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Provider Business Mailing Address
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Address Line | 714 93RD ST
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City | GALVESTON
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State | TX
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Zip | 77554-7186
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Country | US
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Telephone | 719-459-3670
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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 | 01071538
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License Number State | CO
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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 | 109722
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License Number State | TX
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