Provider Demographics
NPI:1477714913
Name:BURGOON, ANDRIA (PLMHP)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:
Last Name:BURGOON
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W PASEWALK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5657
Mailing Address - Country:US
Mailing Address - Phone:402-500-6870
Mailing Address - Fax:
Practice Address - Street 1:1800 W PASEWALK AVE STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5657
Practice Address - Country:US
Practice Address - Phone:402-500-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009922400104100000X
NE13065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker