Healthcare Provider Details

I. General information

NPI: 1285558171
Provider Name (Legal Business Name): MISS MAKAYA BURGESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 LAUREL LINDALE RD
NEW RICHMOND OH
45157-9571
US

IV. Provider business mailing address

505 E 13TH ST APT 1
CINCINNATI OH
45202-7487
US

V. Phone/Fax

Practice location:
  • Phone: 950-226-3767
  • Fax:
Mailing address:
  • Phone: 419-516-7861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20263605-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: