Provider Demographics
NPI:1902116783
Name:MARTIN-BURGOS, SUSANA (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:
Last Name:MARTIN-BURGOS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E. LOS EBANOS BLVD.
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8443
Mailing Address - Country:US
Mailing Address - Phone:956-622-5059
Mailing Address - Fax:956-554-0540
Practice Address - Street 1:425 E. LOS EBANOS BLVD.
Practice Address - Street 2:SUITE 109
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8443
Practice Address - Country:US
Practice Address - Phone:956-622-5059
Practice Address - Fax:956-554-0540
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist