Provider Demographics
NPI:1861121360
Name:BURKS, BRIANNA PAIGE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:PAIGE
Last Name:BURKS
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 1:315 7TH AVE N APT 519
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2368
Mailing Address - Country:US
Mailing Address - Phone:256-417-1997
Mailing Address - Fax:
Practice Address - Street 1:315 7TH AVE N APT 519
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-2368
Practice Address - Country:US
Practice Address - Phone:256-417-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist