Provider Demographics
NPI:1760228878
Name:BURGE, MARY CLAIRE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CLAIRE
Last Name:BURGE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6013
Mailing Address - Country:US
Mailing Address - Phone:601-946-0131
Mailing Address - Fax:
Practice Address - Street 1:4012 PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2378
Practice Address - Country:US
Practice Address - Phone:704-332-4834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist