Provider Demographics
NPI:1619237500
Name:BURQUE, ALLISON DUNN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:DUNN
Last Name:BURQUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-0195
Mailing Address - Country:US
Mailing Address - Phone:773-998-1120
Mailing Address - Fax:773-525-3325
Practice Address - Street 1:3322 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-0195
Practice Address - Country:US
Practice Address - Phone:773-998-1120
Practice Address - Fax:773-525-3325
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0148731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical