Individual
MARY BURNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
131 NW HAWTHORNE AVE STE 103, BEND, OR 97703-2957
(541) 604-8255
Mailing address
131 NW HAWTHORNE AVE STE 103, BEND, OR 97703-2957
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
15729
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144716127
ORGANIZATIONAL NPI
OR
Enumeration date
05/16/2017
Last updated
08/19/2019
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