Provider Demographics
NPI:1184952814
Name:BURZYNSKI, JAMES A (MS, CCC, SLP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:BURZYNSKI
Suffix:
Gender:M
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 CO. RD. 800 E
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62831
Mailing Address - Country:US
Mailing Address - Phone:618-384-8173
Mailing Address - Fax:
Practice Address - Street 1:WABASH CHRISTIAN RETIREMENT CENTER
Practice Address - Street 2:216 COLLEGE BLVD
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821
Practice Address - Country:US
Practice Address - Phone:618-382-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL148007108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist