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General NPI Number Information
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NPI Number | 1275244717
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Entity Type | Organization
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Legal Business Name | BURGO & ASSOCIATES, PLLC
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 350 S NORTHWEST HWY STE 300
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City | PARK RIDGE
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State | IL
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Zip | 60068-4262
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Country | US
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Telephone | 773-219-0836
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Fax | 872-702-6453
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Provider Business Mailing Address
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Address Line | 350 S NORTHWEST HWY STE 300
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City | PARK RIDGE
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State | IL
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Zip | 60068-4262
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Country | US
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Telephone | 773-219-0836
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Fax | 872-702-6453
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Authorized Official
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Title or Position | OWNER AND CLINICAL PSYCHOLOGIST
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Name | DR. IVY BURGO
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Credential | PSYD, LPC, NCC, HSP
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Telephone | 773-219-0836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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