Provider Demographics
NPI:1750130860
Name:MCKENNA-BURKE, AILEEN (LCSW)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:MCKENNA-BURKE
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 1:9007 SAFE HAVEN PL
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6420
Mailing Address - Country:US
Mailing Address - Phone:815-573-4551
Mailing Address - Fax:
Practice Address - Street 1:4745 E SHERRILL RD
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-9921
Practice Address - Country:US
Practice Address - Phone:815-573-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical