Most Relevant Information
Provider Data
| NPI Number: | 1003506908 |
| Provider Name: | CONRAD JAMES BURGHARDT |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/12/2023 |
| Last Updated: | 05/12/2023 |
Provider Practice Location
400 GREEN BAY RD
KENILWORTH
IL
600431001
Practice Location Phone/Fax
| Phone: | 8479199096 |
| Fax: |
Provider Mailing Location
2025 SHERMAN AVE APT 301
EVANSTON
IL
602013267
Provider Mailing Phone/Fax
| Phone: | 8477498796 |
| Fax: |