Provider Demographics
NPI:1225378706
Name:BURDICK, JOCELYN JUDITH (LMT)
Entity Type:Individual
Prefix:MISS
First Name:JOCELYN
Middle Name:JUDITH
Last Name:BURDICK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 OLIVE ST APT 1112
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3986
Mailing Address - Country:US
Mailing Address - Phone:541-505-1955
Mailing Address - Fax:
Practice Address - Street 1:301 W 5TH AVE STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2506
Practice Address - Country:US
Practice Address - Phone:541-687-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19514171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor