Provider Demographics
NPI:1467851717
Name:BURKET, WENDY SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:BURKET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:SUE
Other - Last Name:EICHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2907 PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4305
Mailing Address - Country:US
Mailing Address - Phone:877-626-2500
Mailing Address - Fax:
Practice Address - Street 1:2907 PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4305
Practice Address - Country:US
Practice Address - Phone:877-626-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126518104100000X
PACW0175081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker