Provider Demographics
NPI:1144943929
Name:BOULGOURJIAN, ANNETTE (MS, CF-SLP)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:
Last Name:BOULGOURJIAN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 QUIMBY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3549
Mailing Address - Country:US
Mailing Address - Phone:818-585-2078
Mailing Address - Fax:
Practice Address - Street 1:54 S HIGH ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2102
Practice Address - Country:US
Practice Address - Phone:808-984-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist