Provider Demographics
NPI:1588249643
Name:BURKE, SANDRA LEE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
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 1:259 A ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1009
Mailing Address - Country:US
Mailing Address - Phone:650-274-8744
Mailing Address - Fax:
Practice Address - Street 1:2525 E BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-3210
Practice Address - Country:US
Practice Address - Phone:650-665-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist