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NPI Code Detail

MEDICARE: CARLIE BOULDIN MS, CCC-SLP

MEDICARE:   CARLIE  BOULDIN  MS, CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist3847AL

General Provider Information

NPI Number : 1003286741
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLIE BOULDIN MS, CCC-SLP
Provider Business Mailing Address
First Line : 245 CAHABA VALLEY PKWY
Second Line : STE. 200
City : PELHAM
State : AL
Zip : 35124-2216
Country : US
Telephone Number : 205-942-6820
Fax Number : 205-314-7222
Provider Business Practice Location Address
First Line : 500 SPANISH FORT BLVD
Second Line :
City : SPANISH FORT
State : AL
Zip : 36527-5018
Country : US
Telephone Number : 251-626-8526
Fax Number : 251-626-4878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2015
Last Update Date : 10/06/2015

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Directions to “ CARLIE BOULDIN MS, CCC-SLP” Practice Location

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