Provider Demographics
NPI:1003039157
Name:BURKE, JOHN R (MA CCC-A)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:BURKE
Suffix:
Gender:M
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 CENTRAL PARK DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8816
Mailing Address - Country:US
Mailing Address - Phone:970-879-7286
Mailing Address - Fax:970-879-7677
Practice Address - Street 1:940 CENTRAL PARK DR
Practice Address - Street 2:SUITE 208
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8816
Practice Address - Country:US
Practice Address - Phone:970-879-7286
Practice Address - Fax:970-879-7677
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO57231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07789506Medicaid
COC1533Medicare PIN
COC1533Medicare PIN