MEDICARE: JUDY C BURDINE M.A. CCC-SLP

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	14532	TX
2	235Z00000X	Speech-Language Pathologist	477	AR

Other Identifiers

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

General Provider Information

NPI Number	:	1164640660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY C BURDINE M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	103 BROWER LN
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75501-0336
Country	:	US
Telephone Number	:	903-838-3279
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 N STATE LINE AVE
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-5309
Country	:	US
Telephone Number	:	903-791-2270
Fax Number	:	903-792-0816

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/09/2007

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Directions to “ JUDY C BURDINE M.A. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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