Provider Demographics
NPI:1790134872
Name:BOSTON, BIANCA PATRICE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:PATRICE
Last Name:BOSTON
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 1:5714 QUERCUS COVE CT APT 208
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-0334
Mailing Address - Country:US
Mailing Address - Phone:704-980-8646
Mailing Address - Fax:
Practice Address - Street 1:13739 STEELE CREEK RD UNIT 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-7139
Practice Address - Country:US
Practice Address - Phone:704-980-8646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist