Healthcare Provider Details

I. General information

NPI: 1104041011
Provider Name (Legal Business Name): DAVID ASHLEY BURTON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 ALDRICH AVE S
MINNEAPOLIS MN
55408-4273
US

IV. Provider business mailing address

2920 ALDRICH AVE S
MINNEAPOLIS MN
55408-4273
US

V. Phone/Fax

Practice location:
  • Phone: 412-626-2003
  • Fax:
Mailing address:
  • Phone: 412-626-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31276
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15800
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31343
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015492
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: