Provider Demographics
NPI:1063638286
Name:BURLEY, RITA M (LISW)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:BURLEY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3093 JENNINGS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50579-7688
Mailing Address - Country:US
Mailing Address - Phone:712-210-0451
Mailing Address - Fax:
Practice Address - Street 1:311 S CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3038
Practice Address - Country:US
Practice Address - Phone:712-792-3581
Practice Address - Fax:712-792-2124
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA061191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15231Medicare ID - Type Unspecified