Provider Demographics
NPI:1538388798
Name:BURLEIGH, SUSAN HAMILTON (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:HAMILTON
Last Name:BURLEIGH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MADRMA BEACH DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368
Mailing Address - Country:US
Mailing Address - Phone:206-999-8720
Mailing Address - Fax:206-524-5528
Practice Address - Street 1:23 MADRMA BEACH DRIVE
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368
Practice Address - Country:US
Practice Address - Phone:206-999-8720
Practice Address - Fax:206-524-5528
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHA6960OtherBLUE SHIELD