Individual
JENNIFER BOUTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
204 E NAOMI ST, RANDLEMAN, NC 27317-1844
(336) 267-9046
Mailing address
204 E NAOMI ST, RANDLEMAN, NC 27317-1844
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP21639
NC
Other
Enumeration date
10/10/2016
Last updated
10/10/2016
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