Provider Demographics
NPI:1649799875
Name:BURGERT, DIANE MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:BURGERT
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 1:2014 193RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9646
Mailing Address - Country:US
Mailing Address - Phone:206-910-0013
Mailing Address - Fax:
Practice Address - Street 1:2915 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4265
Practice Address - Country:US
Practice Address - Phone:206-540-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health