Provider Demographics
NPI:1073016267
Name:BURKEMPER, ELLEN M (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:BURKEMPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:EBERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:
Practice Address - Street 1:102 COMPASS POINT DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4404
Practice Address - Country:US
Practice Address - Phone:636-946-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0002431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical