Provider Demographics
NPI:1376612374
Name:BURKHARDT, SANDRA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:A
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ORLAND SQUARE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6523
Mailing Address - Country:US
Mailing Address - Phone:708-364-7046
Mailing Address - Fax:708-364-7048
Practice Address - Street 1:60 ORLAND SQUARE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6548
Practice Address - Country:US
Practice Address - Phone:708-364-7046
Practice Address - Fax:708-364-7048
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004565103TC0700X, 103TC2200X
IN20042496A103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical