Basic Information
| Provider Information | |||||||||
| NPI: | 1780254375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKS | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | CLAIRE | ||||||||
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| Credential: | MS CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 HURON AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622663674 | ||||||||
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| Practice Location | |||||||||
| Address1: | 602 VONDERBURG DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136531149 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2021 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA20602 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.