Provider Demographics
NPI:1487660429
Name:BURTON, ZASHATA LYNNE (LADC LICENSED ALCOHO)
Entity Type:Individual
Prefix:MS
First Name:ZASHATA
Middle Name:LYNNE
Last Name:BURTON
Suffix:
Gender:F
Credentials:LADC LICENSED ALCOHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066
Mailing Address - Country:US
Mailing Address - Phone:651-380-0043
Mailing Address - Fax:651-800-2000
Practice Address - Street 1:520 10TH STREET
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066
Practice Address - Country:US
Practice Address - Phone:651-380-0043
Practice Address - Fax:651-800-2000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300116101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN106221OtherUC
MN51738OtherHP
MN289G6BUOtherBCBS
MN84-61062OtherUBH
MN1043337OtherP1