Individual
ALISA BURKLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
4106 MAID STONE DR, LAKE CHARLES, LA 70605-4030
(337) 540-1861
Mailing address
4106 MAID STONE DR, LAKE CHARLES, LA 70605-4030
(337) 540-1861
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
3856484
LA
235Z00000X
Speech-Language Pathologist
Primary
6299
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2116401
—
LA
Enumeration date
07/12/2010
Last updated
10/20/2023
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