Healthcare Provider Details

I. General information

NPI: 1073979134
Provider Name (Legal Business Name): ANNA BURKE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 10/06/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CHURCH ST SE
MINNEAPOLIS MN
55455-0222
US

IV. Provider business mailing address

410 CHURCH ST SE
MINNEAPOLIS MN
55455-0222
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-1444
  • Fax:
Mailing address:
  • Phone: 612-624-9194
  • Fax: 651-645-7307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00663
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00663
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: