Provider Demographics
NPI:1750059689
Name:BURCHIEL, JESSICA RENAE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENAE
Last Name:BURCHIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2155
Mailing Address - Country:US
Mailing Address - Phone:206-769-1057
Mailing Address - Fax:
Practice Address - Street 1:23 BELLWETHER WAY STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2969
Practice Address - Country:US
Practice Address - Phone:360-389-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist