Provider Demographics
NPI:1376027037
Name:BURCH, BRIDGET ALEXIS (MSED CCC SLP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ALEXIS
Last Name:BURCH
Suffix:
Gender:F
Credentials:MSED CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13280 WOODLAND PARK RD APT 327
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5037
Mailing Address - Country:US
Mailing Address - Phone:716-870-2349
Mailing Address - Fax:
Practice Address - Street 1:11200 WAPLES MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7475
Practice Address - Country:US
Practice Address - Phone:703-237-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist