Provider Demographics
NPI:1164157947
Name:BURKHAMER, MINDY (PEL, LSW, CADC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:BURKHAMER
Suffix:
Gender:F
Credentials:PEL, LSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E TIMBERLAKE TRL
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9477
Mailing Address - Country:US
Mailing Address - Phone:630-337-0827
Mailing Address - Fax:
Practice Address - Street 1:2683 US HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8577
Practice Address - Country:US
Practice Address - Phone:630-551-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1501048071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical