Provider Demographics
NPI:1649724667
Name:BURCKHARD, KRISTI
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:BURCKHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-6050
Mailing Address - Country:US
Mailing Address - Phone:605-262-3002
Mailing Address - Fax:
Practice Address - Street 1:908 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-6050
Practice Address - Country:US
Practice Address - Phone:605-262-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD146-LIMITED235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist