Healthcare Provider Details

I. General information

NPI: 1104068238
Provider Name (Legal Business Name): PASCALE BOURNE MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NW 82ND AVE SUITE 302
PLANTATION FL
33324-7808
US

IV. Provider business mailing address

201 NW 82ND AVE SUITE 302
PLANTATION FL
33324-7808
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-2294
  • Fax: 954-577-2297
Mailing address:
  • Phone: 954-577-2294
  • Fax: 954-577-2297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA6356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: