Provider Demographics
NPI:1730623224
Name:BURKE, SANDY (LCPC)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 E NORTHSHORE LN
Mailing Address - Street 2:PO BOX 398
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-3759
Mailing Address - Country:US
Mailing Address - Phone:618-553-5602
Mailing Address - Fax:
Practice Address - Street 1:4250 E NORTHSHORE LN
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-3759
Practice Address - Country:US
Practice Address - Phone:618-553-5602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional