Provider Demographics
NPI:1356453997
Name:BURGESS, DAWN THOMPSON (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:THOMPSON
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 1:12016 STONEHENGE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7374
Mailing Address - Country:US
Mailing Address - Phone:813-361-8108
Mailing Address - Fax:
Practice Address - Street 1:2765 JEFFERSON DAVIS HWY STE 203
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8331
Practice Address - Country:US
Practice Address - Phone:540-446-5323
Practice Address - Fax:540-720-5660
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty