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Contact Information

STACY BURDICK, DM- BCC (2054)
1230 WESTWOOD DR NW
SALEM, OR97304-3749
 Phone: 971-208-4663
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Mental Health

101YM0800X
 

Religious Nonmedical Practitioner

374K00000X
Indicates primary specialty

NPI Profile & details for STACY BURDICK · (Male)

NPI # 1780399808
Status Active
Credentials DM- BCC (2054)
Entity Individual
Enumeration date 01/23/2023
Last updated 02/14/2023 - About 3 years ago
Sole proprietor 1 Yes
Identifiers
  • FL License # 2054
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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