Healthcare Provider Details

I. General information

NPI: 1245148139
Provider Name (Legal Business Name): EMILEE ROSE BURDICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 COLONIAL DR
BATON ROUGE LA
70806-6505
US

IV. Provider business mailing address

PO BOX 66558
BATON ROUGE LA
70896-6558
US

V. Phone/Fax

Practice location:
  • Phone: 225-922-0478
  • Fax: 888-965-7288
Mailing address:
  • Phone: 225-922-0478
  • Fax: 888-965-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number19696
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: