Individual
GENEVIEVE BOULAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
4870 SANTA MONICA AVE STE 2B, SAN DIEGO, CA 92107-4802
(619) 560-1270
(619) 684-3765
Mailing address
4870 SANTA MONICA AVE STE 2B, SAN DIEGO, CA 92107-4802
(619) 560-1270
(619) 684-3765
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP30340
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP30340
SPEECH-LANGUAGE PATHOLOGY LICENSE
CA
Enumeration date
09/11/2020
Last updated
09/11/2020
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