Basic Information
| Provider Information | |||||||||
| NPI: | 1902227929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURMEISTER | ||||||||
| FirstName: | DONALD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6945 PINE CREEK RD | ||||||||
| Address2: | |||||||||
| City: | MANISTEE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496609555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194914734 | ||||||||
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| Practice Location | |||||||||
| Address1: | 542 16TH ST | ||||||||
| Address2: | |||||||||
| City: | RAWLINS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 823015241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073242759 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2013 | ||||||||
| LastUpdateDate: | 08/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLPS506 | AK | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SI60396745 | WA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 7101005288 | MI | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SLP-SP-LIC-7381 | MT | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SP796 | WY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.