Provider Demographics
NPI:1801247382
Name:BURGESS, JOANNA CATHLEEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:CATHLEEN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:CATHLEEN
Other - Last Name:STEGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:9300 CAMPUS POINT DR
Mailing Address - Street 2:MAIL CODE 7779
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1300
Mailing Address - Country:US
Mailing Address - Phone:858-657-7990
Mailing Address - Fax:858-657-1809
Practice Address - Street 1:9300 CAMPUS POINT DR
Practice Address - Street 2:MAIL CODE 7779
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1300
Practice Address - Country:US
Practice Address - Phone:858-657-7990
Practice Address - Fax:858-657-1809
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12014235Z00000X
CA16900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12014OtherSPEECH PATHOLOGY LICENSE
CA16900OtherSPEECH PATHOLOGY LICENSE