MEDICARE: MRS. ANNE BOON MS CCC-SLP

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	235Z00000X	Speech-Language Pathologist	102164	TX

General Provider Information

NPI Number	:	1578573986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE BOON MS CCC-SLP

Provider Business Mailing Address
First Line	:	1600 W 38TH ST
Second Line	:	STE 320
City	:	AUSTIN
State	:	TX
Zip	:	78731-6400
Country	:	US
Telephone Number	:	512-324-3310
Fax Number	:	512-324-3311

Provider Business Practice Location Address
First Line	:	6811 AUSTIN CENTER BLVD
Second Line	:	STE 400
City	:	AUSTIN
State	:	TX
Zip	:	78731-3146
Country	:	US
Telephone Number	:	512-628-1918
Fax Number	:	512-628-1916

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	04/20/2012

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Directions to “ MRS. ANNE BOON MS CCC-SLP” Practice Location

Language	Start Address	Practice Location

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