Myna Laquisha Burks, M.S. SLP-CCC
Individual provider Active NPI Speech-Language Pathologist · Forest, MS
NPI 1598968802 · NPPES record last updated Oct 26, 2018
Key facts
- NPI
- 1598968802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- S3430 (MS)
- Practice address
- 1129 Highway 35 S Ste 2
Forest, MS 39074-8829 - Phone
- (601) 469-1001
- NPI assigned
- Jun 6, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120730000796 | MS | Practitioner - Qualified Speech Language Pathologist | 6204092687 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP4186 | CA | MD | Speech-Language Pathologist |
| S3430 | MS | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metamorphosis Rehabilitation LLC | Current |
Accepting new patients | |
| Enduracare Acute Care Services LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP4186 | CA | |
| Speech-Language Pathologist | 235Z00000X | S3430 | MS | Yes |
Addresses
Primary practice location
1129 Highway 35 S Ste 2
Forest, MS 39074-8829
Mailing address
2500 North State Street
Jackson, MS 39216-4500
Phone (601) 948-1191
Other practice location 1
2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-5160
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| S3430 | Other | MS | MS STATE LICENSE |
| 05722005 | Medicaid | MS | |
| SP4186 | Other | CA | STATE LICENSE NUMBER |
Other providers in Forest, MS
- Bradley M. Thompson, O.D.,P.a.
- Oddysey K Brewer
- Rori E. Bridges
- Brusha Home Care Service
- Brusha Home Care Services
- Christopher Butler
- Kelly Atkinson Chambers
- John Coleman
- Cathy G Cooper
- Cottonwood Manor II
All providers in Forest, MS · Speech-Language Pathologist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.