Healthcare Provider Details

I. General information

NPI: 1750440640
Provider Name (Legal Business Name): DENISE ANN BURKE MSW LCSW CADC MISAII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE ANN BARGH MSW LCSW CADC MISAII

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 DOCTORS PARK ROAD SUITE H
MT VERNON IL
62864
US

IV. Provider business mailing address

320 W ALLMON ST
SALEM IL
62881
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-0344
  • Fax: 618-244-1455
Mailing address:
  • Phone: 618-740-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: