Basic Information
| Provider Information | |||||||||
| NPI: | 1477566768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMS-BURKLEY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW, CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 PRENTICE ST NORTH | ||||||||
| Address2: | BOX 8004 | ||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544818004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153444611 | ||||||||
| FaxNumber: | 7153448127 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 PRENTICE ST NORTH | ||||||||
| Address2: | BOX 8004 | ||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544818004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153444611 | ||||||||
| FaxNumber: | 7153448127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6833-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 40924100 | 05 | WI | MEDICAID |