Provider Demographics
NPI:1619334893
Name:BURKE, ALLEGRA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLEGRA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 STONEHOLLOW DR # A
Mailing Address - Street 2:#1222
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3130
Mailing Address - Country:US
Mailing Address - Phone:512-698-8245
Mailing Address - Fax:
Practice Address - Street 1:2301 RIDDLE RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1310
Practice Address - Country:US
Practice Address - Phone:512-233-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist