Provider Demographics
NPI:1164612503
Name:BURTON, JAY THOMAS (MA, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:THOMAS
Last Name:BURTON
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 SW 64TH STREET
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9605
Mailing Address - Country:US
Mailing Address - Phone:352-338-4900
Mailing Address - Fax:352-338-4951
Practice Address - Street 1:5415 SW 64TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9605
Practice Address - Country:US
Practice Address - Phone:352-338-4900
Practice Address - Fax:252-338-4951
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY0000215231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist