Provider Demographics
NPI:1336376946
Name:BOULANGER, NICOLE (MS CFY-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BOULANGER
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6865 E BECKER LN STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6730
Mailing Address - Country:US
Mailing Address - Phone:480-991-6560
Mailing Address - Fax:
Practice Address - Street 1:6865 E BECKER LN STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6730
Practice Address - Country:US
Practice Address - Phone:480-991-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP6154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist