Provider Demographics
NPI:1578903415
Name:BOU, NYDIA (EDD, MS-CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:
Last Name:BOU
Suffix:
Gender:F
Credentials:EDD, MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 CAMINO DE LAS AMAPOLAS
Mailing Address - Street 2:URB. VEREDAS
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9684
Mailing Address - Country:US
Mailing Address - Phone:787-743-7979
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 189 KM 3.3
Practice Address - Street 2:UNIVERSIDAD DEL TURABO CLINICA DE HABLA LENGUAJE
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-9684
Practice Address - Country:US
Practice Address - Phone:787-743-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist