Provider Demographics
NPI:1528394947
Name:BOURNE, MARGARET MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:MARIE
Last Name:BOURNE
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 1:1444 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3832
Mailing Address - Country:US
Mailing Address - Phone:415-577-4210
Mailing Address - Fax:
Practice Address - Street 1:122 PAUL DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2030
Practice Address - Country:US
Practice Address - Phone:415-577-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist