MEDICARE: MRS. EMILY BURKHART M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	6174	SC

General Provider Information

NPI Number	:	1760851117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY BURKHART M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1021 2ND AVE N STE 6
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3200
Country	:	US
Telephone Number	:	843-286-5168
Fax Number	:	844-318-8980

Provider Business Practice Location Address
First Line	:	1021 2ND AVE N STE 6
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3200
Country	:	US
Telephone Number	:	843-286-5168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	05/18/2021

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