Doctor Name: | MS. REBECCA BOULLIOUN-DAVIS |
NPI Number: | 1093910028 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S.E.,CCC-SLP |
License Number: | 48 |
Business Practice Address: | 14405 Old River Dr Scott, AR - 721429118 |
Business Phone Number: | 5019619403 |
Business Fax Number: | |
Mailing Address: | 14405 Old River Dr, SCOTT |
State: | AR |
Postal Code: | 721429118 |
Phone Number: | 5019619403 |
Fax Number: | |
NPI Enumeration Date: | 06/19/2007 |
NPI Last Update Date: | 11/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 48 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |