Healthcare Provider Details

I. General information

NPI: 1902726987
Provider Name (Legal Business Name): MAGGIE LYNNAE BURKS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 E VAN TREES ST
WASHINGTON IN
47501-2948
US

IV. Provider business mailing address

421 E VAN TREES ST
WASHINGTON IN
47501-2948
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-2673
  • Fax:
Mailing address:
  • Phone: 812-254-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22009624A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: