Healthcare Provider Details

I. General information

NPI: 1275118317
Provider Name (Legal Business Name): JESSICA J BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 PACKARD AVE
SHERMAN SD
57030-2120
US

IV. Provider business mailing address

111 W MAIN ST STE 1
PIPESTONE MN
56164-1651
US

V. Phone/Fax

Practice location:
  • Phone: 605-310-1767
  • Fax:
Mailing address:
  • Phone: 951-889-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2889
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: