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Organization
PEDIATRIC BOULEVARD, PLLC
Active
Organization
PEDIATRIC BOULEVARD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOINETTE CHRISTINE LAGUERRE MS.,CCC-SLP (DIRECTOR)
(704) 821-0568
Entity
Organization
Contact information
Practice address
2814 GRAY FOX RD, MONROE, NC 28110-8422
(704) 821-0568
(704) 821-0570
Mailing address
2814 GRAY FOX RD, MONROE, NC 28110-8422
(704) 821-0568
(704) 821-0570
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7200741
—
NC
Enumeration date
08/24/2010
Last updated
09/12/2014
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