Active NPI
Todd Hamilton Burdick, PH.D.
- Clinical Psychologist
- Cheyenne, WY
National Provider Identifier
1114164175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3243
- Practice address
- 5601 Canyon Rd
Cheyenne, WY 82009-4545 - Phone
- (307) 634-9082
- NPI assigned
- Jan 13, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3243 | CO | Primary |
Addresses
Primary practice location
5601 Canyon Rd
Cheyenne, WY 82009-4545
Mailing address
5601 Canyon Rd
Cheyenne, WY 82009-4545
Phone (307) 634-9082
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3243 | CO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231804800000",
"number": "1114164175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5601 CANYON RD",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820094545",
"telephone_number": "307-634-9082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5601 CANYON RD",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820094545",
"telephone_number": "307-634-9082"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURDICK",
"first_name": "TODD",
"middle_name": "HAMILTON",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-13",
"last_updated": "2009-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "3243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.