Provider Demographics
NPI:1710425053
Name:THE HONEST EDGE
Entity Type:Organization
Organization Name:THE HONEST EDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-336-7090
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007525251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health