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NPI Code Detail

MEDICARE: MRS. MARY BRIDGET BURLESON M.S. C.C.C. S.L.P.

MEDICARE: MRS. MARY BRIDGET BURLESON M.S. C.C.C. S.L.P.
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
1235Z00000XSpeech-Language PathologistSLP-1092WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649311267
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY BRIDGET BURLESON M.S. C.C.C. S.L.P.
Provider Business Mailing Address
First Line : 354 WAITMAN ST
Second Line :
City : MORGANTOWN
State : WV
Zip : 26501-6458
Country : US
Telephone Number : 304-292-8432
Fax Number :
Provider Business Practice Location Address
First Line : 1160 VAN VOORHIS RD
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-3437
Country : US
Telephone Number : 304-285-1035
Fax Number : 304-598-1100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2007
Last Update Date : 07/09/2007

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Directions to “ MRS. MARY BRIDGET BURLESON M.S. C.C.C. S.L.P.” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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