Provider Demographics
NPI:1053399345
Name:BOURGEOIS, STEVEN C (MA, CCC-A)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:C
Last Name:BOURGEOIS
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 OAK TREE TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7566
Mailing Address - Country:US
Mailing Address - Phone:847-331-4669
Mailing Address - Fax:413-647-4096
Practice Address - Street 1:1020 11TH AVE
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-3102
Practice Address - Country:US
Practice Address - Phone:847-688-5568
Practice Address - Fax:847-688-4430
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003412231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist