Healthcare Provider Details

I. General information

NPI: 1831188549
Provider Name (Legal Business Name): GRETCHEN S BURK M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S JORDAN AVE
BLOOMINGTON IN
47405-7002
US

IV. Provider business mailing address

200 S JORDAN AVE
BLOOMINGTON IN
47405-7002
US

V. Phone/Fax

Practice location:
  • Phone: 812-855-7439
  • Fax:
Mailing address:
  • Phone: 812-855-7439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002332A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: