MEDICARE: MRS. KATHLEEN BURKE BURKE M.S., C.C.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	3309	MA

General Provider Information

NPI Number	:	1134208960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN BURKE BURKE M.S., C.C.C.

Provider Business Mailing Address
First Line	:	37 MAGAZINE ST
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-4810
Country	:	US
Telephone Number	:	603-472-9732
Fax Number	:	603-472-7168

Provider Business Practice Location Address
First Line	:	37 MAGAZINE ST
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-4810
Country	:	US
Telephone Number	:	603-472-9732
Fax Number	:	603-472-7168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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