Provider Demographics
NPI:1750091773
Name:BURCHAM, KAREN (PHD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BURCHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 N DURHAM LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-9735
Mailing Address - Country:US
Mailing Address - Phone:847-373-0991
Mailing Address - Fax:
Practice Address - Street 1:855 E GOLF RD STE 2139
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5225
Practice Address - Country:US
Practice Address - Phone:847-373-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010868103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist