Provider Demographics
NPI:1871946681
Name:BOUMA, ALLISON MARIE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:BOUMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 SHABBONA RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4353
Mailing Address - Country:US
Mailing Address - Phone:708-253-7313
Mailing Address - Fax:
Practice Address - Street 1:311 S REED ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-2050
Practice Address - Country:US
Practice Address - Phone:815-744-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.003794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist