Provider Demographics
NPI:1043234933
Name:BURKHART, WILLIAM A (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:BURKHART
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20056 19TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1211
Mailing Address - Country:US
Mailing Address - Phone:206-365-1435
Mailing Address - Fax:206-365-1428
Practice Address - Street 1:20056 19TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1211
Practice Address - Country:US
Practice Address - Phone:206-365-1435
Practice Address - Fax:206-365-1428
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY1203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000109298Medicare PIN