Healthcare Provider Details

I. General information

NPI: 1174216493
Provider Name (Legal Business Name): KYLE S BURLINGAME M.S. CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 W MERCURY BLVD STE B
HAMPTON VA
23666-1068
US

IV. Provider business mailing address

5219 GLENDORA CT
POWDER SPRINGS GA
30127-5346
US

V. Phone/Fax

Practice location:
  • Phone: 757-644-0644
  • Fax:
Mailing address:
  • Phone: 609-501-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012417
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP011595
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: