Provider Demographics
NPI:1710186499
Name:BUERLE, SANDRA MARYANNE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARYANNE
Last Name:BUERLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 23RD ST S
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-1552
Mailing Address - Country:US
Mailing Address - Phone:703-271-8085
Mailing Address - Fax:
Practice Address - Street 1:8519 TUTTLE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1508
Practice Address - Country:US
Practice Address - Phone:703-451-8041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist