Provider Demographics
NPI:1376238766
Name:BOURRET, CAMILLE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:BOURRET
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20026 VIKINGS CREST LOOP NE APT 1-103
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7671
Mailing Address - Country:US
Mailing Address - Phone:208-720-9793
Mailing Address - Fax:
Practice Address - Street 1:330 MADISON AVE S STE 106
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2544
Practice Address - Country:US
Practice Address - Phone:206-451-4308
Practice Address - Fax:206-451-4309
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist