MEDICARE: COURTNEY MARIE BOULNEMOUR 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	279507	KY
2	235Z00000X	Speech-Language Pathologist	279378	KY

General Provider Information

NPI Number	:	1780310904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MARIE BOULNEMOUR SLP

Provider Business Mailing Address
First Line	:	116 MERIDIAN WAY STE 8
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2876
Country	:	US
Telephone Number	:	859-353-8382
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 MERIDIAN WAY STE 8
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2876
Country	:	US
Telephone Number	:	859-353-8382
Fax Number	:

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

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	08/09/2022

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Directions to “ COURTNEY MARIE BOULNEMOUR SLP” Practice Location

Language	Start Address	Practice Location

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