Provider Demographics
NPI:1417396862
Name:BURTON, LONI
Entity Type:Individual
Prefix:
First Name:LONI
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S BLACK RIVER ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-2219
Mailing Address - Country:US
Mailing Address - Phone:608-269-7489
Mailing Address - Fax:608-785-5330
Practice Address - Street 1:777 S BLACK RIVER ST
Practice Address - Street 2:STE. 1
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2219
Practice Address - Country:US
Practice Address - Phone:608-269-7489
Practice Address - Fax:608-785-5330
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker