Provider Demographics
NPI:1780164418
Name:BOITNOTT, CARRIE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BOITNOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S I 35 E APT 1302
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6905
Mailing Address - Country:US
Mailing Address - Phone:903-748-2493
Mailing Address - Fax:
Practice Address - Street 1:3200 S I 35 E APT 1302
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6905
Practice Address - Country:US
Practice Address - Phone:903-748-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113522235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist