Provider Demographics
NPI:1497524151
Name:BURTON, BROOKE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BURTON
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 1:2038 221ST ST
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-5064
Mailing Address - Country:US
Mailing Address - Phone:312-478-8467
Mailing Address - Fax:
Practice Address - Street 1:2038 221ST ST
Practice Address - Street 2:
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411-5064
Practice Address - Country:US
Practice Address - Phone:312-478-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician