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NPI Code Detail

MEDICARE: MARIE KELLEHER BURKE

MEDICARE: MARIE KELLEHER BURKE
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1942983481
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE KELLEHER BURKE
Provider Business Mailing Address
First Line : 1108 OAK LN
Second Line :
City : WESTERN SPRINGS
State : IL
Zip : 60558-2114
Country : US
Telephone Number : 708-990-6368
Fax Number :
Provider Business Practice Location Address
First Line : 212 S MARION ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-3257
Country : US
Telephone Number : 312-415-5507
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2023
Last Update Date : 08/10/2023

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Directions to “ MARIE KELLEHER BURKE ” Practice Location

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