MEDICARE: MRS. EMILY JO BURGGRAF LCSW

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	1041C0700X	Clinical Social Worker	4929-C	NV

General Provider Information

NPI Number	:	1821252388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY JO BURGGRAF LCSW

Provider Business Mailing Address
First Line	:	2780 S JONES BLVD
Second Line	:	SUITE I
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5628
Country	:	US
Telephone Number	:	702-220-7386
Fax Number	:	702-220-7012

Provider Business Practice Location Address
First Line	:	2780 S JONES BLVD
Second Line	:	SUITE I
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5628
Country	:	US
Telephone Number	:	702-220-7386
Fax Number	:	702-220-7012

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

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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