Jennifer Boulware, SLPA

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

780 Lynnhaven Pkwy Ste 400
Virginia Beach, VA 23452-7332

Phone

(602) 478-3321

NPI assigned

Dec 20, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jennifer M Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1387497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1952722795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 FAIRWAY DR STE 101",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334411834",
            "telephone_number": "877-418-2978",
            "fax_number": "866-500-2186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 LYNNHAVEN PKWY STE 400",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527332",
            "telephone_number": "602-478-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULWARE",
        "first_name": "JENNIFER",
        "name_prefix": "Mrs.",
        "credential": "SLPA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-20",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "AZ",
            "license": "7716",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Karl Botin
• Sanae Bouallali, D.D.S.
• Mariam Sophia Bouanane-Smith, PMHNP-BC
• Danielle Bouldin, PHARMD
• Boulevard Medical Center Inc.
• Boundless Inc
• Kevin B Bounds, M.D.
• Thomas Michael Bousman, PA
• Jessica Misty Bowab, COTA, CHW, DOULA
• Hunter Ashley Bowen

• Behavior Technician in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Behavior Technician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.

Verify at the official NPI Registry.