Provider Demographics
NPI:1982839841
Name:BURDICK, JADE A (CRC)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:A
Last Name:BURDICK
Suffix:
Gender:M
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23300 FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:OK
Mailing Address - Zip Code:74436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 HONOR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1302
Practice Address - Country:US
Practice Address - Phone:918-628-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor