MEDICARE: JANE BURDETTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1194194837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE BURDETTE

Provider Business Mailing Address
First Line	:	2819 CHERRY ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3040
Country	:	US
Telephone Number	:	720-530-4810
Fax Number	:

Provider Business Practice Location Address
First Line	:	2819 CHERRY ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3040
Country	:	US
Telephone Number	:	720-530-4810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	09/23/2015

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Directions to “ JANE BURDETTE ” Practice Location

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