Provider Demographics
NPI:1821252388
Name:BURGGRAF, EMILY JO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JO
Last Name:BURGGRAF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 S JONES BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5628
Mailing Address - Country:US
Mailing Address - Phone:702-220-7386
Mailing Address - Fax:702-220-7012
Practice Address - Street 1:2780 S JONES BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5628
Practice Address - Country:US
Practice Address - Phone:702-220-7386
Practice Address - Fax:702-220-7012
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4929-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical