Provider Demographics
NPI:1871857599
Name:BOLEDOVIC, CARA LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:LYNN
Last Name:BOLEDOVIC
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 1:239 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21793-8112
Mailing Address - Country:US
Mailing Address - Phone:301-845-7804
Mailing Address - Fax:
Practice Address - Street 1:239 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8112
Practice Address - Country:US
Practice Address - Phone:301-845-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist