Provider Demographics
NPI:1396136735
Name:BURKE, PATRICIA D (MS/CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:D
Last Name:BURKE
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 PUESTA DEL SOL PLZ
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3601
Mailing Address - Country:US
Mailing Address - Phone:321-543-0615
Mailing Address - Fax:
Practice Address - Street 1:834 PUESTA DEL SOL PLZ
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3601
Practice Address - Country:US
Practice Address - Phone:321-543-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist