Kathryn Clay Boddicker, MS CC SLP
Individual provider Active NPI Speech-Language Pathologist · Holly Springs, NC
NPI 1245315944 · NPPES record last updated Feb 10, 2016
Key facts
- NPI
- 1245315944
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 5721 (NC)
- Practice address
- 105 Skywater LN
Holly Springs, NC 27540-9489 - Phone
- (919) 244-8640
- Fax
- (919) 267-9383
- NPI assigned
- Oct 25, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5721 | NC | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolina Speech & Language, PLLC | Speech-Language Pathologist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 5721 | NC | Yes |
Addresses
Primary practice location
105 Skywater LN
Holly Springs, NC 27540-9489
Mailing address
105 Skywater LN
Holly Springs, NC 27540-9489
Phone (919) 244-8640
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7211634 | Medicaid | NC |
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All providers in Holly Springs, 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 Feb 10, 2016. 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.