Provider Demographics
NPI:1477765410
Name:BURNS, KATHLEEN RUTH (MS, CCC SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RUTH
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 1:1248 NORTHVALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8801
Mailing Address - Country:US
Mailing Address - Phone:757-474-0983
Mailing Address - Fax:
Practice Address - Street 1:733 VOLVO PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-547-3135
Practice Address - Fax:757-548-3678
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist