MEDICARE: MR. KYLE SCOTT BURLINGAME M.S. CCC-SLP

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	14341900

General Provider Information

NPI Number	:	1174216493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KYLE SCOTT BURLINGAME M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	5219 GLENDORA CT
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-5346
Country	:	US
Telephone Number	:	609-501-7266
Fax Number	:

Provider Business Practice Location Address
First Line	:	1790 POWDER SPRINGS RD SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-4154
Country	:	US
Telephone Number	:	770-919-7799
Fax Number	:

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

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	05/29/2024

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