Genevieve Boulais, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP30340 Issued in CA

Practice address

4870 Santa Monica Ave Ste 2B
San Diego, CA 92107-4802

Phone

(619) 560-1270

Fax

(619) 684-3765

NPI assigned

Sep 11, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ocean Beach Speech

  • Hearing and Speech Clinic/Center
  • San Diego, CA
  • NPI 1659845766
  NPD

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1265047682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4870 SANTA MONICA AVE STE 2B",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921074802",
            "telephone_number": "619-560-1270",
            "fax_number": "619-684-3765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4870 SANTA MONICA AVE STE 2B",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921074802",
            "telephone_number": "619-560-1270",
            "fax_number": "619-684-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULAIS",
        "first_name": "GENEVIEVE",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP30340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH-LANGUAGE PATHOLOGY LICENSE",
            "identifier": "SP30340",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Josie Marie Boucher
• Ronald J Boucher, M.D.
• Martin Gabriel Boudrias, RN
• Matthew Richard Boufford, DMD
• Angela Katherine Bougetz, PHARM.D.
• Daniel Lee Bouland, M.D.
• Marc Patrick Boulanger II, DNP, PMHNP-BC
• Meagan Bouldin, RN BSN
• Elizabeth N Boulette, CRNA
• Boulevard Dental Center

• Speech-Language Pathologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; 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.