Provider Demographics
NPI:1083100549
Name:BURDICK, CHELSEA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:BURDICK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 COUNTY ROAD 12
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NY
Mailing Address - Zip Code:14806-9729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4252 COUNTY ROAD 12
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NY
Practice Address - Zip Code:14806
Practice Address - Country:US
Practice Address - Phone:607-661-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist