MEDICARE: MRS. JACQUELYN MARIE BURDETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1053244095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELYN MARIE BURDETT

Provider Business Mailing Address
First Line	:	360 TURNER WAY
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-2084
Country	:	US
Telephone Number	:	240-687-1009
Fax Number	:

Provider Business Practice Location Address
First Line	:	997 HOOVER RD
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-3325
Country	:	US
Telephone Number	:	910-270-2756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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