Provider Demographics
NPI:1922264019
Name:BOURQUE, KRISTI COLE (MS)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:COLE
Last Name:BOURQUE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21603 PARK TREE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3910
Mailing Address - Country:US
Mailing Address - Phone:281-451-3105
Mailing Address - Fax:281-644-1605
Practice Address - Street 1:21603 PARK TREE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3910
Practice Address - Country:US
Practice Address - Phone:281-451-3105
Practice Address - Fax:281-644-1605
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51192231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist