Provider Demographics
NPI:1104906890
Name:BOURNE, LYNNE M (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:BOURNE
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 1:2831 SW 29TH ST
Mailing Address - Street 2:B
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2002
Mailing Address - Country:US
Mailing Address - Phone:785-271-9932
Mailing Address - Fax:785-271-9937
Practice Address - Street 1:2831 SW 29TH ST
Practice Address - Street 2:B
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2002
Practice Address - Country:US
Practice Address - Phone:785-271-9932
Practice Address - Fax:785-271-9937
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS00227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11840OtherBLUE CROSS