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NPI Code Detail

MEDICARE: SHAWNA MARIE BURNHAM LICSW

MEDICARE: SHAWNA MARIE BURNHAM LICSW
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
1101YA0400XAddiction (Substance Use Disorder) Counselor304730MN
21041C0700XClinical Social Worker26045MN

General Provider Information

NPI Number : 1770099731
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWNA MARIE BURNHAM LICSW
Provider Business Mailing Address
First Line : 112 1ST ST W
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-4002
Country : US
Telephone Number : 218-888-8032
Fax Number : 218-308-6438
Provider Business Practice Location Address
First Line : 112 1ST ST W
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-4002
Country : US
Telephone Number : 218-888-8032
Fax Number : 218-308-6438
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2017
Last Update Date : 02/16/2026

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Directions to “ SHAWNA MARIE BURNHAM LICSW” Practice Location

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