Basic Information
| Provider Information | |||||||||
| NPI: | 1609282524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURSLIE | ||||||||
| FirstName: | LINDSIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4717 NICOLLET AVE APT 4 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554195556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2185917339 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7250 FRANCE AVE S | ||||||||
| Address2: | CAPERNAUM PEDIATRIC THERAPY | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9522852840 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2014 | ||||||||
| LastUpdateDate: | 07/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 9343 | MN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.