Basic Information
| Provider Information | |||||||||
| NPI: | 1003012147 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11811 LAURIE CIR | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995777903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073501323 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10928 EAGLE RIVER RD STE 108 | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995778079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073501323 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 43 | AK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.