Provider Demographics
NPI:1811600505
Name:BURTON, NIKKI D (MAT)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:D
Last Name:BURTON
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:D
Other - Last Name:FESSENDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1840 E LOOKOUT DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9563
Mailing Address - Country:US
Mailing Address - Phone:253-223-7943
Mailing Address - Fax:
Practice Address - Street 1:1840 E LOOKOUT DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9563
Practice Address - Country:US
Practice Address - Phone:253-223-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty