Provider Demographics
NPI:1487908810
Name:BURDZILAUSKAS, ANGIE SUE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:SUE
Last Name:BURDZILAUSKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 MEADOWCREST DR
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-2544
Mailing Address - Country:US
Mailing Address - Phone:618-960-9861
Mailing Address - Fax:
Practice Address - Street 1:733 MEADOWCREST DR
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2544
Practice Address - Country:US
Practice Address - Phone:618-960-9861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110920235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist