Provider Demographics
NPI:1114164175
Name:BURDICK, TODD HAMILTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:HAMILTON
Last Name:BURDICK
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 1:5601 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4545
Mailing Address - Country:US
Mailing Address - Phone:307-634-9082
Mailing Address - Fax:
Practice Address - Street 1:5601 CANYON RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4545
Practice Address - Country:US
Practice Address - Phone:307-634-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3243103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical