Healthcare Provider Details

I. General information

NPI: 1407975600
Provider Name (Legal Business Name): SUSAN WARDLE-BURKE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CHURCHILL HUBBARD RD SUITE A
YOUNGSTOWN OH
44505-1371
US

IV. Provider business mailing address

4675 WOODRIDGE DR
YOUNGSTOWN OH
44515-5108
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-3040
  • Fax: 330-759-3070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE3464
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: