Provider Demographics
NPI:1073971636
Name:BOONE, KATHLEEN (MS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6423 BORDEAUX PARK
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7625
Mailing Address - Country:US
Mailing Address - Phone:210-862-1953
Mailing Address - Fax:
Practice Address - Street 1:6423 BORDEAUX PARK
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7625
Practice Address - Country:US
Practice Address - Phone:210-862-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50114231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist