MEDICARE: DR. KATHERINE S BOURQUE PHD

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	2011021425	MO

General Provider Information

NPI Number	:	1710266515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE S BOURQUE PHD

Provider Business Mailing Address
First Line	:	226 W 66TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-1855
Country	:	US
Telephone Number	:	816-517-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 W 66TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-1855
Country	:	US
Telephone Number	:	816-517-0333
Fax Number	:

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

Provider Enumeration Date	:	08/10/2011
Last Update Date	:	08/10/2011

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