Basic Information
Provider Information
NPI: 1033559364
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PETROZZI-BURGESS
FirstName: ANNE
MiddleName: ELIZABETH
NamePrefix: MRS.
NameSuffix:  
Credential: MS ED. CCC/SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 630 66TH ST
Address2:  
City: NIAGARA FALLS
State: NY
PostalCode: 143042212
CountryCode: US
TelephoneNumber: 7162864211
FaxNumber:  
Practice Location
Address1: 630 66TH ST
Address2:  
City: NIAGARA FALLS
State: NY
PostalCode: 143042212
CountryCode: US
TelephoneNumber: 7162864211
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/01/2013
LastUpdateDate: 08/02/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X022777NYY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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