Provider Demographics
NPI:1629365127
Name:BUDZEK BURR, LISA (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BUDZEK BURR
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 GEORGE SCHNOPP RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01235-9131
Mailing Address - Country:US
Mailing Address - Phone:413-655-0011
Mailing Address - Fax:
Practice Address - Street 1:190 GEORGE SCHNOPP RD
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:MA
Practice Address - Zip Code:01235-9131
Practice Address - Country:US
Practice Address - Phone:413-655-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist