Individual
BROOKLYN BURKHART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3706 MEADOWLARK LN, GREAT BEND, KS 67530-7465
(785) 657-7464
(785) 445-4042
Mailing address
971 E WICHITA AVE, RUSSELL, KS 67665-2444
(785) 657-7464
(785) 445-4042
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07191999
07191999
KS
Enumeration date
11/08/2019
Last updated
11/08/2019
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