Provider Demographics
NPI:1710004478
Name:BURTON, JANICE I (MSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:I
Last Name:BURTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S SHEPHERD RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8966
Mailing Address - Country:US
Mailing Address - Phone:989-775-4850
Mailing Address - Fax:
Practice Address - Street 1:2800 S SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8966
Practice Address - Country:US
Practice Address - Phone:989-775-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085735104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M29340Medicare ID - Type Unspecified