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General NPI Number Information
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NPI Number | 1003864968
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Entity Type | Individual
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Provider Name | DEBORAH ANN BURNELL L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 421 W EXCHANGE ST
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City | FREEPORT
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State | IL
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Zip | 61032-4008
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Country | US
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Telephone | 815-599-7300
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Fax | 815-599-7948
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Provider Business Mailing Address
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Address Line | PO BOX 813 421 W EXCHANGE
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City | FREEPORT
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State | IL
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Zip | 61032
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Country | US
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Telephone | 815-599-7300
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Fax | 815-599-7948
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149005650
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License Number State | IL
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