Individual
KELLIE BOUREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
30503 GREENFIELD RD, SOUTHFIELD, MI 48076-1594
(248) 691-4732
Mailing address
4949 COOLIDGE HWY, ROYAL OAK, MI 48073-1026
(248) 655-5975
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101000845
MI
Other
Enumeration date
11/06/2018
Last updated
12/30/2024
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