Provider Demographics
NPI:1861638108
Name:BURKE, ALICEN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALICEN
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ALICEN
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:12806 20TH ST NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9243
Mailing Address - Country:US
Mailing Address - Phone:425-335-1525
Mailing Address - Fax:425-397-0536
Practice Address - Street 1:12806 20TH ST NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-9243
Practice Address - Country:US
Practice Address - Phone:425-335-1525
Practice Address - Fax:425-397-0536
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60063507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist