Provider Demographics
NPI:1861731945
Name:BURKE, LORI SUE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:SUE
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:EGELHOFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12325 E GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1151
Mailing Address - Country:US
Mailing Address - Phone:509-924-1830
Mailing Address - Fax:509-927-3222
Practice Address - Street 1:22000 E WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:OTIS ORCHARDS
Practice Address - State:WA
Practice Address - Zip Code:99027-9235
Practice Address - Country:US
Practice Address - Phone:509-924-9823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60326367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA235Z00000XMedicaid