Provider Demographics
NPI:1598046641
Name:BURNS, SUE ELLEN (MA, SLP-CCC-L)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ELLEN
Last Name:BURNS
Suffix:
Gender:F
Credentials:MA, SLP-CCC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S. MILWAUKEE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5072
Mailing Address - Country:US
Mailing Address - Phone:847-353-8999
Mailing Address - Fax:
Practice Address - Street 1:401 S. MILWAUKEE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5072
Practice Address - Country:US
Practice Address - Phone:847-353-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146001560235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist