Provider Demographics
NPI:1700275815
Name:BURNHAM, TRISHA M (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:M
Last Name:BURNHAM
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 1:1011 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2506
Mailing Address - Country:US
Mailing Address - Phone:706-226-4623
Mailing Address - Fax:706-278-0580
Practice Address - Street 1:1011 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2506
Practice Address - Country:US
Practice Address - Phone:706-226-4623
Practice Address - Fax:706-278-0580
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist