Provider Demographics
NPI:1639238033
Name:BURDINE, SCOTT E
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:BURDINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 MILDRED ST W
Mailing Address - Street 2:SUITE 134
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6036
Mailing Address - Country:US
Mailing Address - Phone:253-565-0954
Mailing Address - Fax:253-565-3300
Practice Address - Street 1:2310 MILDRED ST W
Practice Address - Street 2:SUITE 134
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-6036
Practice Address - Country:US
Practice Address - Phone:253-565-0954
Practice Address - Fax:253-565-3300
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3626237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist