Provider Demographics
NPI:1114264785
Name:BURTON, ALLYSON HAVIG (SLPA)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:HAVIG
Last Name:BURTON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9837 E OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2114
Mailing Address - Country:US
Mailing Address - Phone:480-773-8014
Mailing Address - Fax:
Practice Address - Street 1:9837 E OSAGE AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2114
Practice Address - Country:US
Practice Address - Phone:480-773-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA81722355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPA8172OtherSLPA LICENSE