Te'Ara Sharae Bouldin

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP013078 Issued in GA

Practice address

120 Latham Dr
Warner Robins, GA 31088-2146

Phone

(478) 887-3141

NPI assigned

Jun 17, 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

Enrolled in GA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• The Weston Group Inc.

  • Physical Therapist
  • Acworth, GA
  • NPI 1841309101

  Speech-Language Pathologist

  Medicare reassignment NPD
• Select Rehabilitation, LLC

  • Rehabilitation Clinic/Center
  • Glenview, IL
  • NPI 1346368248

  Speech-Language Pathologist

  NPD
• The Weston Group Inc.

  • Physical Therapist
  • Easton, PA
  • NPI 1750250759
  NPD

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1861235012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9325 BLUE HOUSE RD APT 10303",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294564228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 LATHAM DR",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310882146",
            "telephone_number": "478-887-3141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDIN",
        "first_name": "TE'ARA",
        "middle_name": "SHARAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP013078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delana Alicia Bongiovanni, NP-C
• Zoeb Bootwala, MD
• Debra Borden
• Hui Bostian
• Jessica Leigh Bostic
• Lacy Boutwell
• Bonnie G. Bower, NP
• Barton Bowers
• Jamie Wright Bowie
• Nicole Boyer

• Speech-Language Pathologist in Warner Robins, GA
• Providers in Warner Robins, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.