| Doctor Name: | JOHANNA BOULT |
| NPI Number: | 1164804423 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 4477 |
| Business Practice Address: | 1450 Claiborne Ave Shreveport, LA - 711034204 |
| Business Phone Number: | 3188132970 |
| Business Fax Number: | 3188132981 |
| Mailing Address: | 1501 Kings Hwy, SHREVEPORT |
| State: | LA |
| Postal Code: | 711034228 |
| Phone Number: | 3188132970 |
| Fax Number: | 3188132981 |
| NPI Enumeration Date: | 06/23/2015 |
| NPI Last Update Date: | 06/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 4477 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| 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 |