Provider Demographics
NPI:1184939704
Name:BURAKOWSKI, KACEY LEIGH
Entity type:Individual
Prefix:MRS
First Name:KACEY
Middle Name:LEIGH
Last Name:BURAKOWSKI
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 1:700 BEACH RD
Mailing Address - Street 2:ELMORE
Mailing Address - City:ELMORE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-2010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 BEACH RD
Practice Address - Street 2:ELMORE
Practice Address - City:ELMORE
Practice Address - State:VT
Practice Address - Zip Code:05661-2010
Practice Address - Country:US
Practice Address - Phone:802-888-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT12095771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist