Provider Demographics
NPI:1992961833
Name:BOUSKA, LINDA (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BOUSKA
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 N TAFT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8307
Mailing Address - Country:US
Mailing Address - Phone:970-663-3222
Mailing Address - Fax:970-663-3227
Practice Address - Street 1:4131 MONTMORENCY PL
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3438
Practice Address - Country:US
Practice Address - Phone:970-663-9579
Practice Address - Fax:970-663-3227
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57923264Medicaid