Provider Demographics
NPI:1255972238
Name:BURCH, JLISIA MARIELLE (SLP-ASSISTANT)
Entity type:Individual
Prefix:
First Name:JLISIA
Middle Name:MARIELLE
Last Name:BURCH
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7840 FM 1960 RD E STE 401
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2258
Mailing Address - Country:US
Mailing Address - Phone:281-548-2458
Mailing Address - Fax:281-348-2456
Practice Address - Street 1:7840 FM 1960 RD E STE 401
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2258
Practice Address - Country:US
Practice Address - Phone:281-548-2458
Practice Address - Fax:281-348-2456
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant