Active NPI
Mary Claire Boudreaux, M.S. CCC-SLP
- Speech-Language Pathologist
- Fort Worth, TX
National Provider Identifier
1295472322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 117337
- Practice address
- 4945 Gage Ave Apt 1411
Fort Worth, TX 76109-1543 - Phone
- (903) 824-8575
- NPI assigned
- May 19, 2022
- Last updated
- May 19, 2022
- Sex
- Female
- Sole proprietor
- No
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 | 117337 | TX | Primary |
Addresses
Primary practice location
4945 Gage Ave Apt 1411
Fort Worth, TX 76109-1543
Mailing address
4945 Gage Ave
Apartment 1411
Fort Worth, TX 76109
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
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117337 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652918400000",
"number": "1295472322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4945 GAGE AVE",
"address_2": "APARTMENT 1411",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4945 GAGE AVE APT 1411",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761091543",
"telephone_number": "903-824-8575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDREAUX",
"first_name": "MARY CLAIRE",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-19",
"last_updated": "2022-05-19",
"certification_date": "2022-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "117337",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.