1881743987 NPI number — DR. KATHLEEN E. SHERRELL PSYD

Table of content: DR. KATHLEEN E. SHERRELL PSYD (NPI 1881743987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881743987 NPI number — DR. KATHLEEN E. SHERRELL PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERRELL
Provider First Name:
KATHLEEN
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881743987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 N MARION ST
Provider Second Line Business Mailing Address:
#308
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60301-1167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-386-3681
Provider Business Mailing Address Fax Number:
709-358-1491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 N MARION ST
Provider Second Line Business Practice Location Address:
#308
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60301-1167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-386-3681
Provider Business Practice Location Address Fax Number:
709-358-1491
Provider Enumeration Date:
01/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)