Healthcare Provider Details

I. General information

NPI: 1346161502
Provider Name (Legal Business Name): DESTINY ALIECE BURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 NEBRASKA AVE
TOLEDO OH
43607-4222
US

IV. Provider business mailing address

5631 SECOR RD APT 98
TOLEDO OH
43623-1955
US

V. Phone/Fax

Practice location:
  • Phone: 419-841-7701
  • Fax: 419-841-1691
Mailing address:
  • Phone: 419-841-7701
  • Fax: 419-841-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: