1053558486 NPI number — MRS. BRITNEY THOMPSON BOULDIN M.S., CCC-SLP

Table of content: DR. KALPANA REJINA INJETY D.O. (NPI 1467658773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053558486 NPI number — MRS. BRITNEY THOMPSON BOULDIN M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOULDIN
Provider First Name:
BRITNEY
Provider Middle Name:
THOMPSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
BRITNEY
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053558486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1323 HOLLY RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTHEWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28105-0364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-258-6865
Provider Business Mailing Address Fax Number:
704-846-2993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1323 HOLLY RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTHEWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28105-0364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-258-6865
Provider Business Practice Location Address Fax Number:
704-846-2993
Provider Enumeration Date:
01/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  6641 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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