Provider Demographics
NPI:1386090199
Name:BURKART, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BURKART
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:PO BOX 2901
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-2901
Mailing Address - Country:US
Mailing Address - Phone:307-527-7060
Mailing Address - Fax:307-587-2497
Practice Address - Street 1:808 NORTH STREET 2531 COUGAR
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-2901
Practice Address - Country:US
Practice Address - Phone:307-527-7060
Practice Address - Fax:307-587-2497
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P9050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist