Provider Demographics
NPI:1629846530
Name:BURNETT, MARGARET MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARIE
Last Name:BURNETT
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:PO BOX 2704
Mailing Address - Street 2:
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247-2704
Mailing Address - Country:US
Mailing Address - Phone:209-765-4374
Mailing Address - Fax:
Practice Address - Street 1:5806 WRANGLER ROAD
Practice Address - Street 2:
Practice Address - City:HATHAWAY PINES
Practice Address - State:CA
Practice Address - Zip Code:95233
Practice Address - Country:US
Practice Address - Phone:209-765-4374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist