Healthcare Provider Details

I. General information

NPI: 1528874831
Provider Name (Legal Business Name): ASHLEE BURKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11560 S KEDZIE AVE
MERRIONETTE PARK IL
60803-4517
US

IV. Provider business mailing address

11560 S KEDZIE AVE
MERRIONETTE PARK IL
60803-4517
US

V. Phone/Fax

Practice location:
  • Phone: 773-343-2663
  • Fax: 708-371-0466
Mailing address:
  • Phone: 708-974-5147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: