Provider Demographics
NPI:1538471693
Name:BURGESS, JULIANNE (MA CCC-SLP CBIS)
Entity Type:Individual
Prefix:MS
First Name:JULIANNE
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MA CCC-SLP CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 KENT RD APT 1
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4665
Mailing Address - Country:US
Mailing Address - Phone:440-971-8877
Mailing Address - Fax:
Practice Address - Street 1:3625 MARSH RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-5823
Practice Address - Country:US
Practice Address - Phone:330-346-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 4806235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01079654OtherASHA
OHSP4806OtherOHIO BOARD OF SLP