Provider Demographics
NPI:1447790886
Name:BURTON, CAROLYN MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:MARIE
Last Name:BURTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 TIMBER WALK CT.
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031
Mailing Address - Country:US
Mailing Address - Phone:703-864-6695
Mailing Address - Fax:888-830-3233
Practice Address - Street 1:4603 TIMBER WALK CT.
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031
Practice Address - Country:US
Practice Address - Phone:703-864-6695
Practice Address - Fax:888-830-3233
Is Sole Proprietor?:No
Enumeration Date:2017-03-05
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist