Provider Demographics
NPI:1831108059
Name:BURNS-TROGDON, CLARA MARGARET (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:MARGARET
Last Name:BURNS-TROGDON
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:PO BOX 1313
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-1313
Mailing Address - Country:US
Mailing Address - Phone:910-642-8881
Mailing Address - Fax:910-642-8205
Practice Address - Street 1:119 W BURKHEAD ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3202
Practice Address - Country:US
Practice Address - Phone:910-642-8881
Practice Address - Fax:910-642-8205
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411339OtherPROVIDER NUMBER