Basic Information
| Provider Information | |||||||||
| NPI: | 1841552353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKHOLDER | ||||||||
| FirstName: | KASSIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34350 RIDGE RD # D12 | ||||||||
| Address2: | |||||||||
| City: | WILLOUGHBY HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440943088 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 22001 FAIRMOUNT BLVD | ||||||||
| Address2: | |||||||||
| City: | SHAKER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441184819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169322800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 06/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | COND. 2012187 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.