Healthcare Provider Details

I. General information

NPI: 1679516959
Provider Name (Legal Business Name): SANDRA LYNN BURT MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 MOUNT BAKER RD SUITE B208
EASTSOUND WA
98245-8931
US

IV. Provider business mailing address

PO BOX 1794
EASTSOUND WA
98245-1794
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-7119
  • Fax: 360-376-6182
Mailing address:
  • Phone: 360-376-7119
  • Fax: 360-376-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00005469
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: