Provider Demographics
NPI:1568433183
Name:BURR, AUDREY (ACSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:BURR
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S. ARTHUR ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2204
Mailing Address - Country:US
Mailing Address - Phone:509-533-5470
Mailing Address - Fax:509-533-0627
Practice Address - Street 1:140 S ARTHUR ST
Practice Address - Street 2:SUITE 415
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2204
Practice Address - Country:US
Practice Address - Phone:509-533-5470
Practice Address - Fax:509-533-0627
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000049741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000371002Medicare ID - Type Unspecified