Individual ProviderKristen BourqueSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address333 1st St N, Suite 200, Jacksonville Beach, FL 32250-6945(866) 490-5038PECOS EnrollmentBased on the most recent information from CMS, provider Kristen Bourque does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1316210107Provider TypeIndividualFull NameBourque, KristenGenderFemaleSole ProprietorYesEnumeration Date2/9/2012Last Updated2/9/2012Contact InformationPractice LocationPractice Address333 1st St N, Suite 200, Jacksonville Beach, FL 32250-6945Phone(866) 490-5038FaxUnlisted FaxMailing LocationMailing Address107 Alandale Ave, Brockton, MA 02301-1770PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicense7271Massachusetts