| Doctor Name: | MRS. KIMBERLY LAINE BURGESS |
| NPI Number: | 1679759740 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., CCC/SLP |
| License Number: | 102554 |
| Business Practice Address: | 4560 Se International Way Ste 100 Milwaukie, OR - 972224628 |
| Business Phone Number: | 9712065200 |
| Business Fax Number: | |
| Mailing Address: | 6800 132nd Pl Se Unit E302, NEWCASTLE |
| State: | WA |
| Postal Code: | 980599111 |
| Phone Number: | 8179954275 |
| Fax Number: | |
| NPI Enumeration Date: | 01/18/2008 |
| NPI Last Update Date: | 12/22/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 102554 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |