Healthcare Provider Details

I. General information

NPI: 1407301427
Provider Name (Legal Business Name): RAELYNN BURGER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 E MAIN ST
SPRING ARBOR MI
49283-9617
US

IV. Provider business mailing address

347 PERSHING AVE
JACKSON MI
49203-1075
US

V. Phone/Fax

Practice location:
  • Phone: 517-930-5479
  • Fax:
Mailing address:
  • Phone: 517-930-5479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116324
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: