Provider Demographics
NPI:1003943606
Name:BURNS, BELINDA K (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:K
Last Name:BURNS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32003
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-2003
Mailing Address - Country:US
Mailing Address - Phone:907-790-2029
Mailing Address - Fax:907-790-2338
Practice Address - Street 1:9049 NINNIS DR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-723-8129
Practice Address - Fax:907-790-2338
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK64235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01096982OtherASHA ACCT #
AK64OtherSTATE OCCUPATIONAL LICENS
AKSP 3723Medicaid