NPIMap

Organization Active NPI

Pediatric Boulevard, PLLC

  • Speech-Language Pathologist
  • Monroe, NC
National Provider Identifier
1114233590
Registry record updated Sep 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
PEDIATRIC BOULEVARD, PLLC
Practice address
2814 Gray Fox Rd
Monroe, NC 28110-8422
Phone
(704) 821-0568
Fax
(704) 821-0570
NPI assigned
Aug 24, 2010
Last updated
Sep 12, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Toinette Christine Laguerre, MS.,CCC-SLPNPI 1790741478
Title
Director
Phone
(704) 821-0568

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU Primary
Behavior Analyst 103K00000X NU

Addresses

Primary practice location

2814 Gray Fox Rd
Monroe, NC 28110-8422

Mailing address

2814 Gray Fox Rd
Monroe, NC 28110-8422
Phone (704) 821-0568

Other identifiers 1

IdentifierTypeStateIssuer
7200741MedicaidNC

National Provider Directory

National Provider Directory

Locations

2814 Gray Fox Rd
Monroe, NC 28110
Phone (704) 288-2070

Practitioners & affiliated clinicians

Practitioners 51

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 51

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410480000000",
    "number": "1114233590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2814 GRAY FOX RD",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281108422",
            "telephone_number": "704-821-0568",
            "fax_number": "704-821-0570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2814 GRAY FOX RD",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281108422",
            "telephone_number": "704-821-0568",
            "fax_number": "704-821-0570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC BOULEVARD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-24",
        "last_updated": "2014-09-12",
        "status": "A",
        "authorized_official_last_name": "LAGUERRE",
        "authorized_official_first_name": "TOINETTE",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-821-0568",
        "authorized_official_credential": "MS.,CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7200741",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.