Provider Demographics
NPI:1457006389
Name:BOERSMA, PATRICIA CONNOLLY (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CONNOLLY
Last Name:BOERSMA
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 1:13502 BARRYKNOLL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-3427
Mailing Address - Country:US
Mailing Address - Phone:281-865-8971
Mailing Address - Fax:
Practice Address - Street 1:13502 BARRYKNOLL LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-3427
Practice Address - Country:US
Practice Address - Phone:281-865-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist