Provider Demographics
NPI:1508754896
Name:BURNING BUSH SPEECH SERVICES
Entity type:Organization
Organization Name:BURNING BUSH SPEECH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWENER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:803-339-0135
Mailing Address - Street 1:2736 CELANESE RD # 3
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8440
Mailing Address - Country:US
Mailing Address - Phone:610-816-8489
Mailing Address - Fax:803-262-2039
Practice Address - Street 1:9948 JACK NICKLAUS DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-0445
Practice Address - Country:US
Practice Address - Phone:803-339-0135
Practice Address - Fax:803-262-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-25
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty