MEDICARE: LARANDA BURROW 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
1	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5Y534	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1366480279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARANDA BURROW S.L.P.

Provider Business Mailing Address
First Line	:	3101 WOODRUFF CREEK DR
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-2678
Country	:	US
Telephone Number	:	501-835-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 WOODRUFF CREEK DR
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-2678
Country	:	US
Telephone Number	:	501-835-6225
Fax Number	:

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/08/2007

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Directions to “ LARANDA BURROW S.L.P.” Practice Location

Language	Start Address	Practice Location

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