Provider Demographics
NPI:1578569901
Name:BURKE, ELIZABETH F (SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:F
Last Name:BURKE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SYCAMORE CIR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3024
Mailing Address - Country:US
Mailing Address - Phone:860-559-8878
Mailing Address - Fax:
Practice Address - Street 1:10 SYCAMORE CIR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3024
Practice Address - Country:US
Practice Address - Phone:860-559-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004246618Medicaid
CT004246618Medicaid