Basic Information
| Provider Information | |||||||||
| NPI: | 1477714913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURGOON | ||||||||
| FirstName: | ANDRIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PLMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 W PASEWALK AVE STE A | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025006870 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1800 W PASEWALK AVE STE A | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025006870 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2008 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LSW.0009922400 | CO | N | Behavioral Health & Social Service Providers | Social Worker | 101YM0800X | 13065 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.