Provider Demographics
NPI:1336973981
Name:BURDEN, LENA RENEE (SLP-INTERN)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:RENEE
Last Name:BURDEN
Suffix:
Gender:F
Credentials:SLP-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 TIMBERWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-2726
Mailing Address - Country:US
Mailing Address - Phone:469-865-5536
Mailing Address - Fax:
Practice Address - Street 1:810 E OLD GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-4524
Practice Address - Country:US
Practice Address - Phone:469-721-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist