Provider Demographics
NPI:1255779229
Name:BURKS, SONYA ALYCE
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:ALYCE
Last Name:BURKS
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 1:2520 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-5005
Mailing Address - Country:US
Mailing Address - Phone:702-428-2512
Mailing Address - Fax:
Practice Address - Street 1:2725 S JONES BLVD
Practice Address - Street 2:104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5605
Practice Address - Country:US
Practice Address - Phone:702-384-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor