Provider Demographics
NPI:1326768466
Name:BOULLIANNE, NICOLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:BOULLIANNE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2330
Mailing Address - Country:US
Mailing Address - Phone:177-425-1003
Mailing Address - Fax:
Practice Address - Street 1:12355 HAGEN RANCH RD UNIT 604
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4180
Practice Address - Country:US
Practice Address - Phone:561-221-0450
Practice Address - Fax:954-827-0591
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2652231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty