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NPI Code Detail

MEDICARE: STEVONA JESSICA LOE BURKS M ED, SUDP, LMHCA

MEDICARE: STEVONA JESSICA LOE BURKS M ED, SUDP, LMHCA
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCP61094387WA
2101YM0800XMental Health CounselorMHCA.MC.70037195WA

General Provider Information

NPI Number : 1073163200
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVONA JESSICA LOE BURKS M ED, SUDP, LMHCA
Provider Business Mailing Address
First Line : 515 3RD AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98104-2304
Country : US
Telephone Number : 206-464-1570
Fax Number :
Provider Business Practice Location Address
First Line : 515 3RD AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98104-2304
Country : US
Telephone Number : 206-464-1570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2019
Last Update Date : 02/16/2026

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