Provider Demographics
NPI:1982383543
Name:BURLESON, GRACE ELIZABETH
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ELIZABETH
Last Name:BURLESON
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 1:43 CHARTER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-2501
Mailing Address - Country:US
Mailing Address - Phone:860-581-3771
Mailing Address - Fax:
Practice Address - Street 1:43 CHARTER ST APT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113-2501
Practice Address - Country:US
Practice Address - Phone:860-581-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist