Provider Demographics
NPI:1528396157
Name:MAKUTA, SARAH E (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:MAKUTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2561
Mailing Address - Country:US
Mailing Address - Phone:309-282-6704
Mailing Address - Fax:309-387-2340
Practice Address - Street 1:252 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2561
Practice Address - Country:US
Practice Address - Phone:309-282-6704
Practice Address - Fax:309-387-2340
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490076771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical