Healthcare Provider Details

I. General information

NPI: 1255679338
Provider Name (Legal Business Name): BOERNE JUST-4-KIDS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 SIDNEY BAKER ST S STE 103
KERRVILLE TX
78028-5980
US

IV. Provider business mailing address

448 SIDNEY BAKER ST S STE 103
KERRVILLE TX
78028-5980
US

V. Phone/Fax

Practice location:
  • Phone: 830-896-3130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number35152
License Number StateTX

VIII. Authorized Official

Name: JENNY HAMPTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 830-896-3130