Provider Demographics
NPI:1346541299
Name:BURSON, JACQULINE SUE (CMT)
Entity Type:Individual
Prefix:
First Name:JACQULINE
Middle Name:SUE
Last Name:BURSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 JFK PKWY UNIT 11F
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3087
Mailing Address - Country:US
Mailing Address - Phone:970-204-0516
Mailing Address - Fax:970-204-6812
Practice Address - Street 1:3938 JFK PKWY UNIT 11F
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3087
Practice Address - Country:US
Practice Address - Phone:970-204-0516
Practice Address - Fax:970-204-6812
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist