Provider Demographics
NPI:1285187047
Name:BOUDREAUX, PAULA (CFY SLP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:CFY SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:BUSINESS TOWER 1, SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7209
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:87 I-10 FRONTAGE RD
Practice Address - Street 2:SUITE 225
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707
Practice Address - Country:US
Practice Address - Phone:409-835-0228
Practice Address - Fax:409-835-0151
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist