MEDICARE: ANDREA BOARMAN 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
1	235Z00000X	Speech-Language Pathologist
2	235Z00000X	Speech-Language Pathologist	14340068	KY

General Provider Information

NPI Number	:	1053025957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA BOARMAN CCC-SLP

Provider Business Mailing Address
First Line	:	2509 MIDDLEGROUND DR
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-4109
Country	:	US
Telephone Number	:	270-316-3542
Fax Number	:	270-240-3681

Provider Business Practice Location Address
First Line	:	3520 NEW HARTFORD RD STE 305
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-4636
Country	:	US
Telephone Number	:	270-240-3681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	01/10/2025

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Directions to “ ANDREA BOARMAN CCC-SLP” Practice Location

Language	Start Address	Practice Location

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