Healthcare Provider Details

I. General information

NPI: 1497681993
Provider Name (Legal Business Name): COLLEEN BARBARA BURKE LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 OSBORNE RD NE
FRIDLEY MN
55432-2718
US

IV. Provider business mailing address

520 OSBORNE RD NE
FRIDLEY MN
55432-2718
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-4397
  • Fax: 763-326-4370
Mailing address:
  • Phone: 763-236-4397
  • Fax: 763-326-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305245
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: