Active NPI
Rebecca Boullioun-Davis, M.S.E.,CCC-SLP
- Speech-Language Pathologist
- Scott, AR
National Provider Identifier
1093910028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 48
- Practice address
- 14405 Old River Dr
Scott, AR 72142-9118 - Phone
- (501) 961-9403
- NPI assigned
- Jun 19, 2007
- Last updated
- Nov 12, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 48 | AR | Primary |
Addresses
Primary practice location
14405 Old River Dr
Scott, AR 72142-9118
Mailing address
14405 Old River Dr
Scott, AR 72142-9118
Phone (501) 961-9403
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48 | AR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257984000000",
"number": "1093910028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14405 OLD RIVER DR",
"city": "SCOTT",
"state": "AR",
"postal_code": "721429118",
"telephone_number": "501-961-9403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14405 OLD RIVER DR",
"city": "SCOTT",
"state": "AR",
"postal_code": "721429118",
"telephone_number": "501-961-9403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULLIOUN-DAVIS",
"first_name": "REBECCA",
"name_prefix": "Ms.",
"credential": "M.S.E.,CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-19",
"last_updated": "2009-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "48",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scott, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.