Provider Demographics
NPI:1538418819
Name:MCBURNIE, KIAN (MA, SLP-CCC, TSSLD)
Entity type:Individual
Prefix:
First Name:KIAN
Middle Name:
Last Name:MCBURNIE
Suffix:
Gender:F
Credentials:MA, SLP-CCC, TSSLD
Other - Prefix:
Other - First Name:KIAN
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 PAINE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 LAKEVIEW CT
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:NY
Practice Address - Zip Code:11941-1209
Practice Address - Country:US
Practice Address - Phone:516-473-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY023358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03811814Medicaid