Provider Demographics
NPI:1194044545
Name:BURGESS, CARMEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:BURGESS
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 1:3304 ARCHDALE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6953
Mailing Address - Country:US
Mailing Address - Phone:919-606-3308
Mailing Address - Fax:
Practice Address - Street 1:186 WIND CHIME CT STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6486
Practice Address - Country:US
Practice Address - Phone:919-870-1280
Practice Address - Fax:919-870-1285
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8873235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist