Provider Demographics
NPI:1528345147
Name:BURKE, JODI K (CSW-PIP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:K
Last Name:BURKE
Suffix:
Gender:F
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2813
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-2813
Mailing Address - Country:US
Mailing Address - Phone:605-342-4789
Mailing Address - Fax:605-399-0833
Practice Address - Street 1:202 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1261
Practice Address - Country:US
Practice Address - Phone:605-342-4789
Practice Address - Fax:605-399-0833
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD466017085OtherBLUE CROSS BLUE SHIELD
SD466017085OtherTRICARE
SD466017085Medicaid
SD466017085Medicaid