Provider Demographics
NPI:1619141702
Name:BOSWELL, LORRAINE (STA)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:STA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9931 HYATT RESORT DR
Mailing Address - Street 2:APARTMENT #524
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6800 PARK TEN BLVD
Practice Address - Street 2:SUITE 135-EAST
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4211
Practice Address - Country:US
Practice Address - Phone:210-734-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338322355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant