Provider Demographics
NPI:1225512486
Name:BURGOS, ALICIA MICHELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MICHELLE
Last Name:BURGOS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:MICHELLE
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:17317 SANTALUCE MNR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3827
Mailing Address - Country:US
Mailing Address - Phone:301-351-4667
Mailing Address - Fax:
Practice Address - Street 1:17317 SANTALUCE MNR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3827
Practice Address - Country:US
Practice Address - Phone:301-351-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04631235Z00000X
FL18770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist