NPIMap

Organization Active NPI

Robert Burkham, PH.D., S.C.

  • Psychologist
  • Appleton, WI
National Provider Identifier
1669700761
Registry record updated Dec 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
991-057 Issued in WI
Legal business name
ROBERT BURKHAM, PH.D., S.C.
Practice address
103 W College Ave
Suite 611
Appleton, WI 54911-5770
Phone
(920) 882-5300
Fax
(920) 882-0747
NPI assigned
Dec 1, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Burkham, PH.D.NPI 1710073804
Title
President
Phone
(920) 882-5300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 991-057 WI Primary

Addresses

Primary practice location

103 W College Ave
Suite 611
Appleton, WI 54911-5770

Mailing address

103 W College Ave
Suite 611
Appleton, WI 54911-5770
Phone (920) 882-5300

National Provider Directory

National Provider Directory

Locations

103 W College Ave
Ste 611
Appleton, WI 54911
Phone (920) 882-5300

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259625600000",
    "number": "1669700761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 W COLLEGE AVE",
            "address_2": "SUITE 611",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115770",
            "telephone_number": "920-882-5300",
            "fax_number": "920-882-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W COLLEGE AVE",
            "address_2": "SUITE 611",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115770",
            "telephone_number": "920-882-5300",
            "fax_number": "920-882-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT BURKHAM, PH.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-01",
        "last_updated": "2009-12-01",
        "status": "A",
        "authorized_official_last_name": "BURKHAM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-882-5300",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "WI",
            "license": "991-057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.

Verify at the official NPI Registry.