Boult, Johanna
Boult, Johanna is an individual health care provider with primary practice located at 1450 Claiborne Ave , Shreveport LA 71103-4204. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Boult, Johanna can be contacted via phone (318) 813-2970.Contact Information
Primary practice address
1450 Claiborne Ave
Shreveport LA 71103-4204
Phone: (318) 813-2970
Fax: (318) 813-2981
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | 4477 | Louisiana |
Profile Details
| NPI number | 1164804423 |
|---|---|
| LBN Legal business name | Boult, Johanna |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 23rd, 2015 |
| Last updated | Jun 23rd, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164804423 | NPPES |
| Louisiana | MEDICAID | 1174173 |
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