Provider Demographics
NPI:1467758961
Name:BURKHART, SHAWNA
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:
Last Name:BURKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 E ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7025
Mailing Address - Country:US
Mailing Address - Phone:630-336-7090
Mailing Address - Fax:
Practice Address - Street 1:1350 N WELLS ST
Practice Address - Street 2:F302
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1936
Practice Address - Country:US
Practice Address - Phone:630-336-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007525101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional