Provider Demographics
NPI:1053000299
Name:BURBACH, ASHLEIGH DAWN
Entity type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:DAWN
Last Name:BURBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 SANDHILL
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2874
Mailing Address - Country:US
Mailing Address - Phone:316-305-9652
Mailing Address - Fax:
Practice Address - Street 1:1824 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-7903
Practice Address - Country:US
Practice Address - Phone:405-230-1168
Practice Address - Fax:580-540-8966
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20109104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker