Provider Demographics
NPI:1841631157
Name:BURKE, ANGELA JOYCE (SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JOYCE
Last Name:BURKE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 DALLAS HWY NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-4466
Mailing Address - Country:US
Mailing Address - Phone:503-363-0497
Mailing Address - Fax:
Practice Address - Street 1:1955 DALLAS HWY NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4466
Practice Address - Country:US
Practice Address - Phone:503-363-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13494OtherOREGON BOARD OF SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY