MEDICARE: ZACHARIAH BURTON LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150.101252	IL

General Provider Information

NPI Number	:	1669843934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARIAH BURTON LSW

Provider Business Mailing Address
First Line	:	630 N FRANKLIN ST
Second Line	:	UNIT 611
City	:	CHICAGO
State	:	IL
Zip	:	60654-8327
Country	:	US
Telephone Number	:	843-597-0225
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 N FRANKLIN ST
Second Line	:	UNIT 611
City	:	CHICAGO
State	:	IL
Zip	:	60654-8327
Country	:	US
Telephone Number	:	843-597-0225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/13/2015

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