Provider Demographics
NPI:1295468452
Name:BURKE, KAITLYN (PHD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 WOODLAND AVE STE 425
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1967
Mailing Address - Country:US
Mailing Address - Phone:515-223-1630
Mailing Address - Fax:
Practice Address - Street 1:3737 WOODLAND AVE STE 425
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1967
Practice Address - Country:US
Practice Address - Phone:515-223-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling