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NPI Code Detail

MEDICARE: JASON MAURICE BURNETT LCSW

MEDICARE: JASON MAURICE BURNETT LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149021328IL

General Provider Information

NPI Number : 1033765326
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON MAURICE BURNETT LCSW
Provider Business Mailing Address
First Line : 1029 DES PLAINES AVE APT 404
Second Line :
City : FOREST PARK
State : IL
Zip : 60130-2146
Country : US
Telephone Number : 312-342-7504
Fax Number :
Provider Business Practice Location Address
First Line : 1029 DES PLAINES AVE APT 404
Second Line :
City : FOREST PARK
State : IL
Zip : 60130-2146
Country : US
Telephone Number : 312-342-7504
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2019
Last Update Date : 08/13/2019

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Directions to “ JASON MAURICE BURNETT LCSW” Practice Location

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