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General NPI Number Information
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NPI Number | 1003821489
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Entity Type | Individual
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Provider Name | LAURIE MARIE BURNETT M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 585 WILEY CT
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-5853
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Country | US
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Telephone | 321-917-0297
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Fax |
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Provider Business Mailing Address
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Address Line | 585 WILEY CT
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-5853
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Country | US
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Telephone | 321-917-0297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202003834
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA 9507
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146007914
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA16056
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License Number State | FL
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