Provider Demographics
NPI:1972373264
Name:BURACZYK, ELISE (SLPA)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:BURACZYK
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 114TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-6302
Mailing Address - Country:US
Mailing Address - Phone:432-400-2295
Mailing Address - Fax:
Practice Address - Street 1:5807 66TH ST APT 2802
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2997
Practice Address - Country:US
Practice Address - Phone:915-621-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX436152355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant