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NPI Code Detail

MEDICARE: MRS. SHERRY GRAHAM NELSON LCSW

MEDICARE:  MRS. SHERRY GRAHAM NELSON  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10001633233OTHERILBLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number : 1174534119
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHERRY GRAHAM NELSON LCSW
Provider Business Mailing Address
First Line : 708 CHURCH ST STE 258
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3840
Country : US
Telephone Number : 847-864-3730
Fax Number :
Provider Business Practice Location Address
First Line : 708 CHURCH ST STE 258
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3840
Country : US
Telephone Number : 847-864-3730
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. SHERRY GRAHAM NELSON LCSW” Practice Location

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