Provider Demographics
NPI:1851859169
Name:BURBANK, DANIELLE ALYSE (SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALYSE
Last Name:BURBANK
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 1:2550 TREASURE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4148
Mailing Address - Country:US
Mailing Address - Phone:805-319-4376
Mailing Address - Fax:
Practice Address - Street 1:2550 TREASURE DR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4148
Practice Address - Country:US
Practice Address - Phone:805-319-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2020-10-29
Deactivation Date:2020-10-10
Deactivation Code:
Reactivation Date:2020-10-28
Provider Licenses
StateLicense IDTaxonomies
CA15143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist