Provider Demographics
NPI:1972954162
Name:BURCKHARD, AVA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:BURCKHARD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:
Other - Last Name:BRERETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:306 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-4145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4501 COLEMAN ST N SUITE #103
Practice Address - Street 2:PEDIATRIC THERAPY PARTNERS
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503
Practice Address - Country:US
Practice Address - Phone:701-751-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist