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General NPI Number Information
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NPI Number | 1548638166
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Entity Type | Organization
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Legal Business Name | EMPOWERED THERAPY, INC
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE SUITE 715
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City | CHICAGO
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State | IL
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Zip | 60601-7511
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Country | US
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Telephone | 847-562-6376
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N KINGSBURY ST APT. 1112
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City | CHICAGO
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State | IL
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Zip | 60610-7432
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Country | US
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Telephone | 847-562-6376
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ELIZABETH JILL BURKE
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Credential | LCSW
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Telephone | 847-562-6376
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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 | 149016042
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License Number State | IL
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