Provider Demographics
NPI:1841991544
Name:BURTON-LODER, EMMA L (LCSW)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:L
Last Name:BURTON-LODER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:L
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2710 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-1543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2710 17TH ST
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-1543
Practice Address - Country:US
Practice Address - Phone:773-358-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0210021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical