Provider Demographics
NPI:1821389503
Name:BURKE, DEBRA J (AUD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:J
Last Name:BURKE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 JOE WIMBERLEY BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5975
Mailing Address - Country:US
Mailing Address - Phone:512-847-2421
Mailing Address - Fax:
Practice Address - Street 1:120 JOE WIMBERLEY BLVD
Practice Address - Street 2:STE 104
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5975
Practice Address - Country:US
Practice Address - Phone:512-847-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80465231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist