Provider Demographics
NPI:1477744829
Name:BOONE, REWA (MEDCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REWA
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:MEDCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 SUGAR LAND ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-4481
Mailing Address - Country:US
Mailing Address - Phone:985-232-1393
Mailing Address - Fax:
Practice Address - Street 1:227 E TWELFTH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:LA
Practice Address - Zip Code:70374-2667
Practice Address - Country:US
Practice Address - Phone:985-532-8936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3680235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1474118Medicaid