MEDICARE: MS. COURTNEY BONE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1154608008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COURTNEY BONE

Provider Business Mailing Address
First Line	:	3435 JEFFERSON AVE
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-2747
Country	:	US
Telephone Number	:	870-772-3371
Fax Number	:	870-772-2602

Provider Business Practice Location Address
First Line	:	3435 JEFFERSON AVE
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-2747
Country	:	US
Telephone Number	:	870-772-3371
Fax Number	:	870-772-2602

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	11/07/2011

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Directions to “ MS. COURTNEY BONE ” Practice Location

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