Healthcare Provider Details

I. General information

NPI: 1407406069
Provider Name (Legal Business Name): XYLEM PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 W BELMONT AVE STE 204
CHICAGO IL
60657-3048
US

IV. Provider business mailing address

1608 W BELMONT AVE STE 204
CHICAGO IL
60657-3048
US

V. Phone/Fax

Practice location:
  • Phone: 312-899-6764
  • Fax:
Mailing address:
  • Phone: 616-901-2101
  • Fax: 312-269-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SARAH BURNETTE
Title or Position: OWNER
Credential: LCSW
Phone: 312-899-6764