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General NPI Number Information
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NPI Number | 1396014494
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Entity Type | Individual
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Provider Name | CATHY ANN BURTLESS M.S., CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 99 GREELEY AVE
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City | SAYVILLE
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State | NY
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Zip | 11782-2300
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Country | US
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Telephone | 631-244-6725
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Fax |
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Provider Business Mailing Address
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Address Line | 215 5TH ST
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City | SAINT JAMES
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State | NY
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Zip | 11780-2420
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Country | US
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Telephone | 631-584-3273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 58012720
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License Number State | NY
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