Provider Demographics
NPI:1811105034
Name:BURLISON, LAURETTE HINTON (MSP, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURETTE
Middle Name:HINTON
Last Name:BURLISON
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 CHARLESTON OAK CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2272
Mailing Address - Country:US
Mailing Address - Phone:770-822-5229
Mailing Address - Fax:
Practice Address - Street 1:6075 ATLANTIC BLVD
Practice Address - Street 2:SUITE G-1
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1349
Practice Address - Country:US
Practice Address - Phone:770-209-9826
Practice Address - Fax:770-209-9876
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004809235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist