Provider Demographics
NPI:1275118317
Name:BURKE, JESSICA J
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:BURKE
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 1:111 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1651
Mailing Address - Country:US
Mailing Address - Phone:951-889-1987
Mailing Address - Fax:
Practice Address - Street 1:95 PACKARD AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:SD
Practice Address - Zip Code:57030-2120
Practice Address - Country:US
Practice Address - Phone:605-310-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN2889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health