Provider Demographics
NPI:1396574208
Name:BURLOCK, EMILY ROSE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:BURLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:ROSE
Other - Last Name:BURLOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:885 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9309
Mailing Address - Country:US
Mailing Address - Phone:541-760-7157
Mailing Address - Fax:
Practice Address - Street 1:861 SW MADISON AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4512
Practice Address - Country:US
Practice Address - Phone:541-974-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical