MEDICARE: BRIANNE BURGOON

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	221700000X	Art Therapist

General Provider Information

NPI Number	:	1619764982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNE BURGOON

Provider Business Mailing Address
First Line	:	42230 UTICA RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-3644
Country	:	US
Telephone Number	:	248-939-6211
Fax Number	:

Provider Business Practice Location Address
First Line	:	42230 UTICA RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-3644
Country	:	US
Telephone Number	:	248-939-6211
Fax Number	:

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

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/21/2025

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Directions to “ BRIANNE BURGOON ” Practice Location

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