Provider Demographics
NPI:1063164119
Name:MARY BIRKEY PC
Entity type:Organization
Organization Name:MARY BIRKEY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CISZEK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-641-4767
Mailing Address - Street 1:19625 BEECHNUT DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9333
Mailing Address - Country:US
Mailing Address - Phone:708-641-4767
Mailing Address - Fax:
Practice Address - Street 1:21 S WHITE ST UNIT 3
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-4007
Practice Address - Country:US
Practice Address - Phone:815-662-5480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health