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General NPI Number Information
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NPI Number | 1770938797
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Entity Type | Individual
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Provider Name | KYLIE BOUTTE SLP
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Gender | Female
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 304 LA RUE FRANCE STE 108
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City | LAFAYETTE
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State | LA
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Zip | 70508-3136
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Country | US
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Telephone | 337-242-7931
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Fax |
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Provider Business Mailing Address
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Address Line | 304 LA RUE FRANCE STE 108
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City | LAFAYETTE
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State | LA
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Zip | 70508-3136
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Country | US
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Telephone | 337-242-7931
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Fax | 337-282-8015
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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 | 7384
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License Number State | LA
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