Melissa Bourgoin, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

0736 Issued in NH

Practice address

715 Riverwood Dr
Pembroke, NH 03275-3701

Phone

(603) 225-2715

NPI assigned

Oct 15, 2020

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Boothby Therapy Services, LLC

  • Occupational Therapist
  • Laconia, NH
  • NPI 1770797094
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 15, 2020.

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1306444872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 N MAIN ST",
            "city": "LACONIA",
            "state": "NH",
            "postal_code": "032462603",
            "telephone_number": "603-524-9090",
            "fax_number": "603-524-1497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 RIVERWOOD DR",
            "city": "PEMBROKE",
            "state": "NH",
            "postal_code": "032753701",
            "telephone_number": "603-225-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGOIN",
        "first_name": "MELISSA",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-15",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NH",
            "license": "0736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allenstown School District
• Mary Margarita Bacon, ARNP
• Anna Kerimov Bahr, PHARMD
• Sarah Anne Bell, PA-C
• Catherine Anne Bemis, P.T.
• Tara Brochu
• Sara E Cannuli, MS
• Chichester School District
• John Clifton Chulada, ATC
• Teresa Cimini

• All providers in Pembroke, NH
• Speech-Language Pathologist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.