Provider Demographics
NPI:1235364811
Name:BOONE, ANGELA BOURQUE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BOURQUE
Last Name:BOONE
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 1:398 SANDPIPER PL
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-5409
Mailing Address - Country:US
Mailing Address - Phone:337-662-1167
Mailing Address - Fax:
Practice Address - Street 1:398 SANDPIPER PL
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-5409
Practice Address - Country:US
Practice Address - Phone:337-662-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist