Provider Demographics
NPI:1588849699
Name:CARROLL-BURKE, DENISE ANN
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ANN
Last Name:CARROLL-BURKE
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 1:10636 S TRUMBULL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2555
Mailing Address - Country:US
Mailing Address - Phone:773-909-9011
Mailing Address - Fax:
Practice Address - Street 1:10636 S TRUMBULL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2555
Practice Address - Country:US
Practice Address - Phone:773-909-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist