Provider Demographics
NPI:1134208960
Name:BURKE, KATHLEEN BURKE (MS, CCC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:BURKE
Last Name:BURKE
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4810
Mailing Address - Country:US
Mailing Address - Phone:603-472-9732
Mailing Address - Fax:603-472-7168
Practice Address - Street 1:37 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-4810
Practice Address - Country:US
Practice Address - Phone:603-472-9732
Practice Address - Fax:603-472-7168
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist