Provider Demographics
NPI:1992941850
Name:BURGTORF, JOANNA MICHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MICHELLE
Last Name:BURGTORF
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:MICHELLE
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11101 HEFNER POINTE DR.
Mailing Address - Street 2:
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:405-720-9812
Mailing Address - Fax:405-720-9815
Practice Address - Street 1:11101 HEFNER POINTE DR.
Practice Address - Street 2:
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-720-9812
Practice Address - Fax:405-720-9815
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist