Healthcare Provider Details

I. General information

NPI: 1891891578
Provider Name (Legal Business Name): KATHLEEN ANNE BURCH M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 N 2ND ST STE 103
FULTON NY
13069-1254
US

IV. Provider business mailing address

98 N 2ND ST STE 103
FULTON NY
13069-1254
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4806
  • Fax: 315-464-5321
Mailing address:
  • Phone: 315-349-5828
  • Fax: 315-349-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001460-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: