Provider Demographics
NPI:1770329401
Name:BURDICK, EMMA LOUISE (MS, LCPC)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:LOUISE
Last Name:BURDICK
Suffix:
Gender:
Credentials:MS, LCPC
Other - Prefix:MS
Other - First Name:EMMA
Other - Middle Name:LOUISE
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 N 2800 EAST RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:IL
Mailing Address - Zip Code:61957-1280
Mailing Address - Country:US
Mailing Address - Phone:309-634-1252
Mailing Address - Fax:
Practice Address - Street 1:1305 N 2800 EAST RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:IL
Practice Address - Zip Code:61957-1280
Practice Address - Country:US
Practice Address - Phone:309-634-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018561101YP2500X
IL180.017039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional