Provider Demographics
NPI:1134714314
Name:BURKLE, JOHANNAH (MA)
Entity type:Individual
Prefix:
First Name:JOHANNAH
Middle Name:
Last Name:BURKLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 BOWLING ST SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5005
Mailing Address - Country:US
Mailing Address - Phone:319-862-1050
Mailing Address - Fax:319-862-1052
Practice Address - Street 1:3601 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-2363
Practice Address - Country:US
Practice Address - Phone:319-390-4611
Practice Address - Fax:319-390-4381
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)