Provider Demographics
NPI:1619109659
Name:BOUDET, ASHLEIGH KATE (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:KATE
Last Name:BOUDET
Suffix:
Gender:F
Credentials: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 1:2244 NAPONE LN
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-7808
Mailing Address - Country:US
Mailing Address - Phone:407-451-3228
Mailing Address - Fax:
Practice Address - Street 1:2810 RULEME ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6527
Practice Address - Country:US
Practice Address - Phone:352-357-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist