Individual
JADE BURBANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
954 E PRUDHOMME ST, OPELOUSAS, LA 70570-8239
(337) 772-9772
Mailing address
101 LO SAAB CV, LAFAYETTE, LA 70506-6279
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7651
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7651
—
LA
Enumeration date
08/26/2019
Last updated
08/26/2019
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