Individual
MR. JON BURNHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2691 S 2000 W, REXBURG, ID 83440-4049
(208) 701-9616
Mailing address
108 S AUSTIN AVE, SUGAR CITY, ID 83448-5078
(208) 201-1300
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-27607
ID
Other
Enumeration date
04/09/2007
Last updated
06/02/2023
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