Healthcare Provider Details

I. General information

NPI: 1184952814
Provider Name (Legal Business Name): JAMES A BURZYNSKI M.S, CCC, SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WABASH CHRISTIAN RETIREMENT CENTER 216 COLLEGE BLVD
CARMI IL
62821
US

IV. Provider business mailing address

1457 CO. RD. 800 E
CARMI IL
62831
US

V. Phone/Fax

Practice location:
  • Phone: 618-382-4644
  • Fax:
Mailing address:
  • Phone: 618-384-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number148007108
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: