Provider Demographics
NPI:1902227929
Name:BURMEISTER, DONALD
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:BURMEISTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6945 PINE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9555
Mailing Address - Country:US
Mailing Address - Phone:919-491-4734
Mailing Address - Fax:
Practice Address - Street 1:542 16TH ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5241
Practice Address - Country:US
Practice Address - Phone:307-324-2759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKSLPS506235Z00000X
WASI60396745235Z00000X
MI7101005288235Z00000X
MTSLP-SP-LIC-7381235Z00000X
WYSP796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist