Provider Demographics
NPI:1730198375
Name:BURDICK, LEE A (MA LLP)
Entity type:Individual
Prefix:MS
First Name:LEE
Middle Name:A
Last Name:BURDICK
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 AUSTRIAN PINEWAY
Mailing Address - Street 2:13A
Mailing Address - City:PORTUGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024
Mailing Address - Country:US
Mailing Address - Phone:269-329-2595
Mailing Address - Fax:
Practice Address - Street 1:7130 AUSTRIAN PINEWAY
Practice Address - Street 2:13A
Practice Address - City:PORTUGE
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-329-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008991103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist