Provider Demographics
NPI:1306436688
Name:BURKS, DIONNE L
Entity type:Individual
Prefix:MS
First Name:DIONNE
Middle Name:L
Last Name:BURKS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DIONNE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHW
Mailing Address - Street 1:3323 E 117TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3845
Mailing Address - Country:US
Mailing Address - Phone:216-266-1768
Mailing Address - Fax:
Practice Address - Street 1:3323 E 117TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-3845
Practice Address - Country:US
Practice Address - Phone:216-266-1768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 347C00000X
OHCHW002575172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No347C00000XTransportation ServicesPrivate Vehicle