Provider Demographics
NPI:1073143053
Name:BURLISON, ALETT R (BI, IS)
Entity Type:Individual
Prefix:
First Name:ALETT
Middle Name:R
Last Name:BURLISON
Suffix:
Gender:F
Credentials:BI, IS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 N MENDELSON AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4864
Mailing Address - Country:US
Mailing Address - Phone:208-573-2526
Mailing Address - Fax:
Practice Address - Street 1:4527 N MENDELSON AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4864
Practice Address - Country:US
Practice Address - Phone:208-573-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst