Provider Demographics
NPI:1053558486
Name:BOULDIN, BRITNEY THOMPSON (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRITNEY
Middle Name:THOMPSON
Last Name:BOULDIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:BRITNEY
Other - Middle Name:RENEE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1323 HOLLY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-0364
Mailing Address - Country:US
Mailing Address - Phone:704-258-6865
Mailing Address - Fax:704-846-2993
Practice Address - Street 1:1323 HOLLY RIDGE DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-0364
Practice Address - Country:US
Practice Address - Phone:704-258-6865
Practice Address - Fax:704-846-2993
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist