Provider Demographics
NPI:1184388613
Name:BOURNE INTELLIGENT
Entity type:Organization
Organization Name:BOURNE INTELLIGENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NAILAH
Authorized Official - Middle Name:FEMI
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:917-932-3463
Mailing Address - Street 1:125 BEVERLY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3603
Mailing Address - Country:US
Mailing Address - Phone:833-326-8763
Mailing Address - Fax:
Practice Address - Street 1:125 BEVERLY AVE STE 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3603
Practice Address - Country:US
Practice Address - Phone:833-326-8763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty