MEDICARE: LISA C BURDGE MA, 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	3123	NC

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
2	19914	OTHER	NC	NC BCBS

General Provider Information

NPI Number	:	1669477733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA C BURDGE MA, CCC-SLP

Provider Business Mailing Address
First Line	:	2288 GEORGE HAYES RD
Second Line	:
City	:	BOONE
State	:	NC
Zip	:	28607-8493
Country	:	US
Telephone Number	:	828-757-6226
Fax Number	:	828-757-6289

Provider Business Practice Location Address
First Line	:	1031 MORGANTON BLVD SW
Second Line	:
City	:	LENOIR
State	:	NC
Zip	:	28645-5677
Country	:	US
Telephone Number	:	828-757-6226
Fax Number	:	828-757-6289

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/13/2016

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