Provider Demographics
NPI:1427472810
Name:BURR, MICHAELA J (LICSW)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:J
Last Name:BURR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 WYNDHAM PL
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-8587
Mailing Address - Country:US
Mailing Address - Phone:651-285-3206
Mailing Address - Fax:
Practice Address - Street 1:1320 S FRONTAGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2684
Practice Address - Country:US
Practice Address - Phone:651-500-0905
Practice Address - Fax:651-437-2616
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical