Carolyn Elizabeth Boudreaux, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

05663 Issued in MD

Practice address

2900 Charlevoix Dr SE
Suite 200
Grand Rapids, MI 49546-7085

Phone

(800) 325-8064

Fax

(800) 325-1326

NPI assigned

Apr 23, 2008

Last updated

Apr 23, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208908800000",
    "number": "1558536342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1748 E HERMITAGE ST",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707374914",
            "telephone_number": "225-715-3753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 CHARLEVOIX DR SE",
            "address_2": "SUITE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467085",
            "telephone_number": "800-325-8064",
            "fax_number": "800-325-1326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAUX",
        "first_name": "CAROLYN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MD",
            "license": "05663",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "5657",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Bouchard, DDS
• Charity Bouchard, PA
• Kristin D. Bouche, CRNA
• Christina Boucher
• Sarah Boucher
• Michelle L Boudreaux, LMSW
• Sarah Boulerice
• Hany Boulos, DDS
• Christopher Michael Bouma, DNP, AGPCNP-BC, RN
• Douglas A Bouman, PSYSLLP

• Speech-Language Pathologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Speech-Language Pathologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.

Verify at the official NPI Registry.