Basic Information
| Provider Information | |||||||||
| NPI: | 1023123759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | FRANKLIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985929630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609182955 | ||||||||
| FaxNumber: | 3602451000 | ||||||||
| Practice Location | |||||||||
| Address1: | 237 PROFESSIONAL WAY | ||||||||
| Address2: | |||||||||
| City: | SHELTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985844404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604262500 | ||||||||
| FaxNumber: | 3604262787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 06/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 00003899 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.