Individual
KASEY M BOURKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
6202 CONSTITUTION DR STE D, FORT WAYNE, IN 46804-1583
(260) 432-0066
Mailing address
6202 CONSTITUTION DR STE D, FORT WAYNE, IN 46804-1583
(260) 432-0066
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34010557A
IN
Other
Enumeration date
12/23/2020
Last updated
12/19/2023
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