Provider Demographics
NPI:1669784500
Name:BOURNE, MARY E (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
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 1:5611 S BILOXI WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5847
Mailing Address - Country:US
Mailing Address - Phone:405-315-2441
Mailing Address - Fax:
Practice Address - Street 1:5611 S BILOXI WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5847
Practice Address - Country:US
Practice Address - Phone:405-315-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist