Provider Demographics
NPI:1194574038
Name:BURTON, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5278 E IL HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:IL
Mailing Address - Zip Code:62898-4234
Mailing Address - Country:US
Mailing Address - Phone:618-214-5469
Mailing Address - Fax:
Practice Address - Street 1:1790 NATIONS DR
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9164
Practice Address - Country:US
Practice Address - Phone:618-214-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health