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General NPI Number Information
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NPI Number | 1477938942
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Entity Type | Organization
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Legal Business Name | BOERNE SPEECH THERAPY, LLC
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 18 SCENIC LOOP RD STE 200
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City | BOERNE
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State | TX
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Zip | 78006-8672
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Country | US
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Telephone | 830-331-2083
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 RIVER RD BLDG 6
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City | BOERNE
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State | TX
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Zip | 78006-2487
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Country | US
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Telephone | 830-331-8604
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Fax | 866-923-0869
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Authorized Official
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Title or Position | OWNER
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Name | JENNICA NICOLE COLVIN
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Credential |
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Telephone | 830-331-8604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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