Provider Demographics
NPI:1689808529
Name:LIGHTBURN, ANITA L
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:L
Last Name:LIGHTBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GEBBIE CLINICS
Mailing Address - Street 2:805 S. CROUSE AVE.
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13244-0001
Mailing Address - Country:US
Mailing Address - Phone:315-443-9647
Mailing Address - Fax:315-443-4413
Practice Address - Street 1:GEBBIE CLINICS
Practice Address - Street 2:805 S. CROUSE AVE.
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-0001
Practice Address - Country:US
Practice Address - Phone:315-443-9647
Practice Address - Fax:315-443-4413
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010114-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist