Individual
MR. GEORGE AURTHUR BURNETT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
180 N DATE ST, TRUTH OR CONSEQUENCES, NM 87901-2824
(505) 740-2118
Mailing address
PO BOX 363, ELEPHANT BUTTE, NM 87935-0363
(505) 740-2118
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2503
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2503
STATE SLP LICENSE
NM
05
—
72832
—
NM
Enumeration date
01/25/2007
Last updated
07/09/2007
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