Provider Demographics
NPI:1376757641
Name:BURKHOLDER, DONNA JEAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 SW AVALON WAY
Mailing Address - Street 2:#504
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-4443
Mailing Address - Country:US
Mailing Address - Phone:206-300-3463
Mailing Address - Fax:
Practice Address - Street 1:1507 WESTERN AVE
Practice Address - Street 2:#603
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1563
Practice Address - Country:US
Practice Address - Phone:206-686-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000056811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical