Healthcare Provider Details

I. General information

NPI: 1679842595
Provider Name (Legal Business Name): HEATHER MAE BURKE SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13455 SE 97TH AVE
CLACKAMAS OR
97015-8662
US

IV. Provider business mailing address

2316 SE 44TH AVE
PORTLAND OR
97215-3722
US

V. Phone/Fax

Practice location:
  • Phone: 503-675-4000
  • Fax:
Mailing address:
  • Phone: 480-777-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberA0611
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: