Healthcare Provider Details

I. General information

NPI: 1003864968
Provider Name (Legal Business Name): DEBORAH ANN BURNELL L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W EXCHANGE ST
FREEPORT IL
61032-4008
US

IV. Provider business mailing address

PO BOX 813 421 W EXCHANGE
FREEPORT IL
61032
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-7300
  • Fax: 815-599-7948
Mailing address:
  • Phone: 815-599-7300
  • Fax: 815-599-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149005650
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: