Arvis Bennett Boughman, MACCCSLP
Individual provider Active NPI Speech-Language Pathologist · Drexel, NC
NPI 1194872275 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1194872275
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP 4704 (NC)
- Practice address
- 202 Mimosa Drive
Drexel, NC 28619-2795 - Phone
- (828) 443-4395
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP 4704 | NC | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP 4704 | NC | Yes |
Addresses
Primary practice location
202 Mimosa Drive
Drexel, NC 28619-2795
Mailing address
PO Box 2795
202 Mimosa Drive
Drexel, NC 28619-2795
Phone (828) 443-4395
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7411307 | Medicaid | NC |
Other providers in Drexel, NC
- Appalachian Medical- Health and Wellness, PLLC
- Autumn Corporation
- Channon Berry
- Christina M Biggerstaff
- Destiny Management Incorporated
- Focus Behavioral Health Services, LLC
- Handi-Care, Inc.
- Handi-Care, Inc.
- Timothy Lee Tucker
All providers in Drexel, NC · Speech-Language Pathologist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.