Healthcare Provider Details

I. General information

NPI: 1073851515
Provider Name (Legal Business Name): AMY H BURNHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ERMER RD UNIT 102
SALEM NH
03079-1273
US

IV. Provider business mailing address

29 HAWTHORNE CIR
SOMERSWORTH NH
03878-1635
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-0984
  • Fax: 603-898-4385
Mailing address:
  • Phone: 603-969-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1193
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: