Provider Demographics
NPI:1023197217
Name:BOURGEOIS, JESSICA F (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:F
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 JANIN RD
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-7300
Mailing Address - Country:US
Mailing Address - Phone:337-839-1496
Mailing Address - Fax:
Practice Address - Street 1:220 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5906
Practice Address - Country:US
Practice Address - Phone:337-893-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist