Healthcare Provider Details

I. General information

NPI: 1861008104
Provider Name (Legal Business Name): CONNOR BURGESS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5213 COLUMBIA DR S
SEATTLE WA
98108-1923
US

IV. Provider business mailing address

5213 COLUMBIA DR S
SEATTLE WA
98108-1923
US

V. Phone/Fax

Practice location:
  • Phone: 303-898-9907
  • Fax:
Mailing address:
  • Phone: 303-898-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: