Provider Demographics
NPI:1245526011
Name:BURKE-BENDZUNAS, MOLLIE M (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:M
Last Name:BURKE-BENDZUNAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:MOLLIE
Other - Middle Name:M
Other - Last Name:BURKE-BENDZUNAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:7732 WILLISTON RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-5259
Mailing Address - Country:US
Mailing Address - Phone:802-598-2164
Mailing Address - Fax:
Practice Address - Street 1:7732 WILLISTON RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-5259
Practice Address - Country:US
Practice Address - Phone:802-598-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2023-09-06
Deactivation Date:2014-08-19
Deactivation Code:
Reactivation Date:2023-09-06
Provider Licenses
StateLicense IDTaxonomies
VT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist