Jason Maurice Burnett, LCSW
Individual provider Active NPI Clinical Social Worker · Forest Park, IL
NPI 1033765326 · NPPES record last updated Aug 13, 2019
Key facts
- NPI
- 1033765326
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149021328 (IL)
- Practice address
- 1029 Des Plaines Ave Apt 404
Forest Park, IL 60130-2146 - Phone
- (312) 342-7504
- NPI assigned
- Aug 13, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149021328 | IL | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149021328 | IL | Yes |
Addresses
Primary practice location
1029 Des Plaines Ave Apt 404
Forest Park, IL 60130-2146
Mailing address
1029 Des Plaines Ave Apt 404
Forest Park, IL 60130-2146
Phone (312) 342-7504
Other providers in Forest Park, IL
- Anna Bretschneider
- Brooke Management Corp
- Melanie Brosnan
- Caitlyn Brown
- Ellen C Buchanan
- Sarah Burton
- Dawn M Bushma
- Susan M Buss
- Calm Mind Counseling Center, PLLC
- Jenny Cam
All providers in Forest Park, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.