Doctor Name: | MRS. MARY BRIDGET BURLESON |
NPI Number: | 1649311267 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. C.C.C. S.L.P. |
License Number: | SLP-1092 |
Business Practice Address: | 1160 Van Voorhis Rd Morgantown, WV - 265053437 |
Business Phone Number: | 3042851035 |
Business Fax Number: | 3045981100 |
Mailing Address: | 354 Waitman St, MORGANTOWN |
State: | WV |
Postal Code: | 265016458 |
Phone Number: | 3042928432 |
Fax Number: | |
NPI Enumeration Date: | 02/08/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP-1092 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |