Jennifer Boutwell, MA, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP21639 Issued in NC

Practice address

204 E Naomi St
Randleman, NC 27317-1844

Phone

(336) 267-9046

NPI assigned

Oct 10, 2016

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

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476057600000",
    "number": "1639629900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 E NAOMI ST",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273171844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E NAOMI ST",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273171844",
            "telephone_number": "336-267-9046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTWELL",
        "first_name": "JENNIFER",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-10",
        "last_updated": "2016-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "SP21639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• American Healthcare Systems, LLC
• American Human Services, Inc.
• Balance Therapeutics
• Behavioral Health Services
• Matthew Bishop, PHARMD
• Brookstone Haven of Randleman, LLC
• Pearlie Bullock
• Jasmine Renee Butler
• Nathan Patrick Cassidy
• CDT Healthcare

• Speech-Language Pathologist in Randleman, NC
• Providers in Randleman, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; 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.