Provider Demographics
NPI:1568668820
Name:BOULSE, TERRA LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:LYNN
Last Name:BOULSE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27805 MARIPOSA RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-5726
Mailing Address - Country:US
Mailing Address - Phone:303-670-7149
Mailing Address - Fax:
Practice Address - Street 1:1008 BETHEL AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:360-870-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist