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NPI Code Detail

MEDICARE: STEPHANIE MAUREEN BURDICK

MEDICARE: STEPHANIE MAUREEN BURDICK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianID

General Provider Information

NPI Number : 1053270710
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE MAUREEN BURDICK
Provider Business Mailing Address
First Line : 2959 S MERIDIAN RD
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-7961
Country : US
Telephone Number : 478-449-5378
Fax Number :
Provider Business Practice Location Address
First Line : 2959 S MERIDIAN RD
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-7961
Country : US
Telephone Number : 478-449-5378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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Directions to “ STEPHANIE MAUREEN BURDICK ” Practice Location

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