Individual
IVY BOUDREAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1236 PINE FOREST CIR, ROUND ROCK, TX 78665-5648
(512) 415-1320
Mailing address
1236 PINE FOREST CIR, ROUND ROCK, TX 78665-5648
(512) 415-1320
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
120704
IA
133V00000X
Registered Dietitian
Primary
DT82046
TX
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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