Provider Demographics
NPI:1578871737
Name:BURROUGHS, MELISSA ELIZABETH (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 GLENWILLOW DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1304
Mailing Address - Country:US
Mailing Address - Phone:716-523-2991
Mailing Address - Fax:
Practice Address - Street 1:2253 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2349
Practice Address - Country:US
Practice Address - Phone:716-834-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist