MEDICARE: DR. PEGGY JOANNE BURKE PH.D.

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
1	103T00000X	Psychologist	6301007618	MI
2	103TA0700X	Adult Development & Aging Psychologist	6301007618	MI
3	103TB0200X	Cognitive & Behavioral Psychologist	6301007618	MI
4	103TC0700X	Clinical Psychologist	6301007618	MI
5	103TC2200X	Clinical Child & Adolescent Psychologist	6301007618	MI

General Provider Information

NPI Number	:	1124230644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEGGY JOANNE BURKE PH.D.

Provider Business Mailing Address
First Line	:	4467 CASCADE RD., SE
Second Line	:	SUITE 4469
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3632
Country	:	US
Telephone Number	:	616-940-1659
Fax Number	:	616-940-2853

Provider Business Practice Location Address
First Line	:	4467 CASCADE RD., SE
Second Line	:	SUITE 4469
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3632
Country	:	US
Telephone Number	:	616-940-1659
Fax Number	:	616-940-2853

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	09/11/2025

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Directions to “ DR. PEGGY JOANNE BURKE PH.D.” Practice Location

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