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NPI Code Detail

MEDICARE: MRS. MARCIE A BURNHAM

MEDICARE:  MRS. MARCIE A BURNHAM
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
1235Z00000XSpeech-Language PathologistSP#1589AR
2235Z00000XSpeech-Language Pathologist09135167MD

Other Identifiers

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

General Provider Information

NPI Number : 1558516658
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARCIE A BURNHAM
Provider Business Mailing Address
First Line : 78 ROCK CREEK DR
Second Line :
City : MOUNTAIN HOME
State : AR
Zip : 72653-5851
Country : US
Telephone Number : 870-425-1501
Fax Number :
Provider Business Practice Location Address
First Line : 78 ROCK CREEK DR
Second Line :
City : MOUNTAIN HOME
State : AR
Zip : 72653-5851
Country : US
Telephone Number : 870-425-1501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2008
Last Update Date : 11/18/2008

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Directions to “ MRS. MARCIE A BURNHAM ” Practice Location

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