Healthcare Provider Details

I. General information

NPI: 1518939784
Provider Name (Legal Business Name): SUSAN L BURK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 HILLCREST RD
BEDFORD IN
47421-3023
US

IV. Provider business mailing address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 812-279-3591
  • Fax: 812-275-0787
Mailing address:
  • Phone: 812-339-1691
  • Fax: 812-337-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003707A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: