Provider Demographics
NPI:1548484306
Name:BURDICK, JESSICA MILCHAK (LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MILCHAK
Last Name:BURDICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 S 550 E
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4559
Mailing Address - Country:US
Mailing Address - Phone:801-580-6095
Mailing Address - Fax:
Practice Address - Street 1:2350 S 550 E
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4559
Practice Address - Country:US
Practice Address - Phone:801-580-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6918021-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical