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General NPI Number Information
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NPI Number | 1588520449
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Entity Type | Individual
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Provider Name | JENNIFER A BOURQUE
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Gender | Female
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 18 COMPUTER DR E STE 105
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City | ALBANY
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State | NY
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Zip | 12205-1290
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Country | US
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Telephone | 518-818-0053
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Fax |
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Provider Business Mailing Address
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Address Line | 583 MAPLE ST
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City | WETHERSFIELD
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State | CT
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Zip | 06109-3732
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Country | US
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Telephone | 518-207-6601
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 008552
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License Number State | NY
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