Provider Demographics
NPI:1669023289
Name:BURDICK, JENNIFER P
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:BURDICK
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 1:15370 RING RD
Mailing Address - Street 2:
Mailing Address - City:BRANT
Mailing Address - State:MI
Mailing Address - Zip Code:48614-9791
Mailing Address - Country:US
Mailing Address - Phone:989-598-5679
Mailing Address - Fax:
Practice Address - Street 1:1321 S FAYETTE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-1447
Practice Address - Country:US
Practice Address - Phone:989-598-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)