Victoria Bourne

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP-0038 Issued in WV

Practice address

108 1/2 Spruce St
Bluefield, VA 24605-1738

Phone

(276) 322-5511

Fax

(276) 322-2525

NPI assigned

Mar 11, 2008

Last updated

Apr 9, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Four Seasons Rehab, Inc.

  • Hearing and Speech Clinic/Center
  • Bluefield, VA
  • NPI 1164527628
  Authorized official Same address or phone
• Barbara Samuels, M.a. Dba

  dba Center for Communication Disorders

  • Speech-Language Pathologist
  • Woodland, CA
  • NPI 1295730315
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1720258338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 536",
            "city": "BLUEFIELD",
            "state": "VA",
            "postal_code": "246050536",
            "telephone_number": "276-322-5511",
            "fax_number": "276-322-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 1/2 SPRUCE ST",
            "city": "BLUEFIELD",
            "state": "VA",
            "postal_code": "246051738",
            "telephone_number": "276-322-5511",
            "fax_number": "276-322-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURNE",
        "first_name": "VICTORIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-11",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WV",
            "license": "SLP-0038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0154598000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bluefield Regional Medical Center Inc (Bluefield Internal Medicine)
• Bluefield Vascular Center
• Bluefield Virginia Rescue Squad, Inc. (Bluefield VA Rescue Squad)
• Bluestone Health Association, Inc. (Bluestone Health Clinic)
• Meghan Lee Bohach
• Natalie Lisa Bowling
• Virginia Faye Bradley, DNP PMHNP
• Brain Matters Therapy, PLLC
• Brain Matters Therapy, PLLC
• Jacqueline Hastings Brown, VCU MSW INTERN

• Speech-Language Pathologist in Bluefield, VA
• Providers in Bluefield, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.