Provider Demographics
NPI:1225257413
Name:BURKE BODEN, HEIDI E (MSW)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:E
Last Name:BURKE BODEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:E
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LSCSW
Mailing Address - Street 1:1400 112TH AVE SE
Mailing Address - Street 2:#205
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-454-5772
Mailing Address - Fax:
Practice Address - Street 1:1400 112TH AVE SE
Practice Address - Street 2:#205
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00006416104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker