Provider Demographics
NPI:1457542821
Name:BURCHETTE, ANDREA H (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:H
Last Name:BURCHETTE
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5403
Mailing Address - Country:US
Mailing Address - Phone:910-483-4002
Mailing Address - Fax:910-483-8462
Practice Address - Street 1:2823 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5403
Practice Address - Country:US
Practice Address - Phone:910-483-4002
Practice Address - Fax:910-483-8462
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND7412370Medicaid