Provider Demographics
NPI:1881331767
Name:BURKE, RONALD LEE
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:LEE
Last Name:BURKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 VALLEY RIVER DR STE 395
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2132
Mailing Address - Country:US
Mailing Address - Phone:541-393-8169
Mailing Address - Fax:
Practice Address - Street 1:1750 E VILLA DR STE E
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4687
Practice Address - Country:US
Practice Address - Phone:928-634-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD12957237700000X
HAS-T-10226678237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist