Healthcare Provider Details

I. General information

NPI: 1134301476
Provider Name (Legal Business Name): BRUCE FRANKLIN BURGO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 EAST ST
IOLA KS
66749-4402
US

IV. Provider business mailing address

PO BOX 33029
KANSAS CITY MO
64114-0029
US

V. Phone/Fax

Practice location:
  • Phone: 785-350-4751
  • Fax:
Mailing address:
  • Phone: 816-524-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004763
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: