Individual
MYNA LAQUISHA BURKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. SLP-CCC
Contact information
Practice address
1129 HIGHWAY 35 S STE 2, FOREST, MS 39074-8829
(601) 469-1001
Mailing address
2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 948-1191
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3430
MS
235Z00000X
Speech-Language Pathologist
SP4186
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05722005
—
MS
01
—
S3430
MS STATE LICENSE
MS
01
—
SP4186
STATE LICENSE NUMBER
CA
Enumeration date
06/06/2007
Last updated
10/26/2018
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