Provider Demographics
NPI:1407000136
Name:BURCH, NANCY J (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:BURCH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:BURCH-HALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:78 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2012
Mailing Address - Country:US
Mailing Address - Phone:845-565-8216
Mailing Address - Fax:
Practice Address - Street 1:78 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2012
Practice Address - Country:US
Practice Address - Phone:845-565-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0053061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist