1891075586 NPI number — CHELSEA BERNDL MADDOCK SHERRINGTON M.A., L.P.C.

Table of content: CHELSEA BERNDL MADDOCK SHERRINGTON M.A., L.P.C. (NPI 1891075586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891075586 NPI number — CHELSEA BERNDL MADDOCK SHERRINGTON M.A., L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADDOCK SHERRINGTON
Provider First Name:
CHELSEA
Provider Middle Name:
BERNDL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MADDOCK
Provider Other First Name:
CHELSEA
Provider Other Middle Name:
BERNDL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891075586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 W EUGENIE ST
Provider Second Line Business Mailing Address:
UNIT H
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60614-6067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-480-5528
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
938 W NELSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-296-3169
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2011

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: 101YP2500X , with the licence number:  178007128 , 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)





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