Provider Demographics
NPI:1538707617
Name:BOURGEOIS, RAYLIE KAY (BS, SLP-A)
Entity type:Individual
Prefix:
First Name:RAYLIE
Middle Name:KAY
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:BS, SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41445 HEARTHSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5781
Mailing Address - Country:US
Mailing Address - Phone:225-588-0370
Mailing Address - Fax:
Practice Address - Street 1:9541 BROOKLINE AVE STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1591
Practice Address - Country:US
Practice Address - Phone:225-248-0477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist