Sarah Kertz, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008598 Issued in IL

Practice address

625 Wham Dr
Room 141
Carbondale, IL 62901-4313

Phone

(618) 453-2361

Fax

(618) 453-6130

NPI assigned

Nov 18, 2015

Last updated

Jun 16, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 25, 2025 through Sep 25, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anxiety Specialists of St. Louis

  • Clinical Psychologist
  • Saint Louis, MO
  • NPI 1689338113
  NPD Authorized official
• Southern Illinois University Carbondale Clinical Center

  • Psychologist
  • Carbondale, IL
  • NPI 1174919351
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466035200000",
    "number": "1376917021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 WHAM DR",
            "address_2": "ROOM 141",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629014313",
            "telephone_number": "618-453-2361",
            "fax_number": "618-453-6130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 WHAM DR",
            "address_2": "ROOM 141",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629014313",
            "telephone_number": "618-453-2361",
            "fax_number": "618-453-6130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERTZ",
        "first_name": "SARAH",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-18",
        "last_updated": "2016-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jodie Kennedy, L.C.S.W.
• Gardner Thomas Kenny, M.D.
• Christopher Ryan Kent
• Teresa Ann Kent, LCSW, ACSW
• Emily Elise Kermicle, PA-C
• Marta Elisa Ketter, SLP M.S.
• Refat Daherdiab Khader, M.D.
• Muhammad A Khan, MD
• Rizwan Ahmad Khan, M.D.
• Saqib Khan, MD

• Clinical Psychologist in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.