Healthcare Provider Details

I. General information

NPI: 1417824699
Provider Name (Legal Business Name): SARAH BURDICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CHITTYVILLE RD
HERRIN IL
62948-3552
US

IV. Provider business mailing address

2001 BRUNKHORST AVE
GRAND TOWER IL
62942-1214
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-0190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.113223
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: