Healthcare Provider Details

I. General information

NPI: 1609713619
Provider Name (Legal Business Name): ROOT'D PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 EILEEN ST
DECATUR IL
62521-8885
US

IV. Provider business mailing address

3223 EILEEN ST
DECATUR IL
62521-8885
US

V. Phone/Fax

Practice location:
  • Phone: 217-690-2281
  • Fax:
Mailing address:
  • Phone: 217-690-2281
  • Fax:

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: SARA ANDERSON
Title or Position: OWNER, THERAPIST
Credential: LCSW
Phone: 314-650-3804