Provider Demographics
NPI:1104942002
Name:BOUBIN, FELICIA (AUD)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:BOUBIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 S PATTERSON BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2642
Mailing Address - Country:US
Mailing Address - Phone:937-496-2620
Mailing Address - Fax:937-424-8518
Practice Address - Street 1:1222 S PATTERSON BLVD
Practice Address - Street 2:STE 400
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2642
Practice Address - Country:US
Practice Address - Phone:937-496-2620
Practice Address - Fax:937-424-8518
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA0531231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000321647OtherANTHEM