Provider Demographics
NPI:1669616371
Name:BURKHART, MELINDA T-O (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:T-O
Last Name:BURKHART
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 EASTMAN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6481
Mailing Address - Country:US
Mailing Address - Phone:805-650-6290
Mailing Address - Fax:805-650-6912
Practice Address - Street 1:1601 EASTMAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6481
Practice Address - Country:US
Practice Address - Phone:805-650-6290
Practice Address - Fax:805-650-6912
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist