Healthcare Provider Details

I. General information

NPI: 1568916187
Provider Name (Legal Business Name): KARLA BUERKLE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 WAYZATA BLVD STE 216I
MINNETONKA MN
55305-2031
US

IV. Provider business mailing address

11900 WAYZATA BLVD STE 216E
MINNETONKA MN
55305-2031
US

V. Phone/Fax

Practice location:
  • Phone: 952-545-3300
  • Fax:
Mailing address:
  • Phone: 952-545-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4048
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: