Basic Information
| Provider Information | |||||||||
| NPI: | 1821110206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 BUCHANAN ST SW | ||||||||
| Address2: | |||||||||
| City: | RONAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598643003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066760458 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9 14TH AVE W | ||||||||
| Address2: | |||||||||
| City: | POLSON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598605321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068834378 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP1081 | MT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.