MEDICARE: DR. KENNETH SHERRY

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
1	103T00000X	Psychologist	1303	WI

General Provider Information

NPI Number	:	1649355041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH SHERRY

Provider Business Mailing Address
First Line	:	10012 W CAPITOL DR
Second Line	:	205
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10012 W CAPITOL DR
Second Line	:	205
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1338
Country	:	US
Telephone Number	:	414-578-8500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. KENNETH SHERRY ” Practice Location

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