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NPI Code Detail

MEDICARE: LISA BURGER CCC-SLP

MEDICARE:   LISA  BURGER  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
1235Z00000XSpeech-Language PathologistI-43082-LCA

General Provider Information

NPI Number : 1598742314
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA BURGER CCC-SLP
Provider Business Mailing Address
First Line : 1301 W PROVIDENCE AVE
Second Line :
City : ORANGE
State : CA
Zip : 92868-3808
Country : US
Telephone Number : 714-639-4990
Fax Number :
Provider Business Practice Location Address
First Line : 1301 W PROVIDENCE AVE
Second Line :
City : ORANGE
State : CA
Zip : 92868-3808
Country : US
Telephone Number : 714-639-4990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 07/08/2007

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Directions to “ LISA BURGER CCC-SLP” Practice Location

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