Individual
LORI BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSTCCCSLP
Contact information
Practice address
2795 PILOT KNOB RD, SUITE 100, EAGAN, MN 55121-1119
(651) 994-9644
(651) 994-8962
Mailing address
4058 DEERWOOD TRL, EAGAN, MN 55122-1889
(651) 994-9644
(651) 994-8962
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7211
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4600338
MEDICA
MN
05
—
500043200
—
MN
01
—
963S1BU
BCBS
MN
01
—
HP30988
HEALTH PARTNERS
MN
Enumeration date
02/07/2007
Last updated
07/09/2007
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