1154890309 NPI number — BRIANNA BURROUGHS LICSW

Table of content: BRIANNA BURROUGHS LICSW (NPI 1154890309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154890309 NPI number — BRIANNA BURROUGHS LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURROUGHS
Provider First Name:
BRIANNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIEMI
Provider Other First Name:
BRIANNA
Provider Other Middle Name:
RACHEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154890309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
526 AZTALAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53718-3205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-566-1669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 S PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53715-1596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-417-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  10201-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LW60842772 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)