Active NPI
Larry Boles, PH.D.
- Speech-Language Pathologist
- Sacramento, CA
National Provider Identifier
1225280100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP4884
- Practice address
- 46 Sandburg Dr
Sacramento, CA 95819-1833 - Phone
- (916) 531-2009
- Fax
- (916) 278-7730
- NPI assigned
- Oct 22, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | SP4884 | CA | Primary |
Addresses
Primary practice location
46 Sandburg Dr
Sacramento, CA 95819-1833
Mailing address
46 Sandburg Dr
Sacramento, CA 95819-1833
Phone (916) 531-2009
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP4884 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224633600000",
"number": "1225280100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46 SANDBURG DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958191833",
"telephone_number": "916-531-2009",
"fax_number": "916-278-7730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "46 SANDBURG DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958191833",
"telephone_number": "916-531-2009",
"fax_number": "916-278-7730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLES",
"first_name": "LARRY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-22",
"last_updated": "2008-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "SP4884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.