Aaryn Alexa Boudreaux, M.A. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

202371 Issued in AR

Practice address

3162 W Martin Luther King Jr Blvd Ste 2
Fayetteville, AR 72704-7679

Phone

(479) 435-6636

NPI assigned

Feb 15, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

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.

• Kindred Pediatric Therapy, PLC

  • Physical Therapy Clinic/Center
  • Fayetteville, AR
  • NPI 1508574963
  NPD (past)

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

{
    "created_epoch": "1707955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1295590677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3162 W MARTIN LUTHER KING JR BLVD STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727047679",
            "telephone_number": "479-435-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3162 W MARTIN LUTHER KING JR BLVD STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727047679",
            "telephone_number": "479-435-6636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAUX",
        "first_name": "AARYN",
        "middle_name": "ALEXA",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AR",
            "license": "202371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynn Boothe, MHPP
• Aaron Paul Borengasser, PA-C
• Megan I Borter
• Kristin Bosc, PHD
• Camille E Boswell, LPC
• Shelby L Bourne, LCSW
• Rhonda Lee Bouvier
• Sarah Elizabeth Bowen, D.D.S.
• Walisi Ann Bowen, PT
• Lisa Bowers, PH.D. CCC-SLP

• All providers in Fayetteville, AR
• Speech-Language Pathologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; 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.