Individual
MS. SUSAN DICKENS BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCCSLP
Contact information
Practice address
5724 DUNN HALL, ROOM 336 UNIVERSITY OF MAINE, ORONO, ME 04469-5724
(207) 581-2008
(207) 581-2060
Mailing address
17 BURGESS ROAD, NEWPORT, ME 04493-3600
(207) 581-2008
(207) 581-2060
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP934
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027997
ANTHEM BCBS
ME
Enumeration date
12/06/2006
Last updated
07/08/2007
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