Individual
STEVEN D BURDETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13 DOS LOCOS, LOS LUNAS, NM 87031-5014
(505) 559-0164
(505) 212-1141
Mailing address
23510 ENCHANTED VW, SAN ANTONIO, TX 78260-4318
(505) 559-0164
(505) 212-1141
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
531
NM
235Z00000X
Speech-Language Pathologist
Primary
3285
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16975766
—
NM
Enumeration date
04/09/2019
Last updated
04/09/2019
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