MEDICARE: SHARON J. KLINGMAN MS, CADC, LCPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	180000652	IL
2	101YP2500X	Professional Counselor	180000652	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05732028	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1760405401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON J. KLINGMAN MS, CADC, LCPC

Provider Business Mailing Address
First Line	:	PO BOX 2451
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61702-2451
Country	:	US
Telephone Number	:	309-268-2172
Fax Number	:	309-268-3649

Provider Business Practice Location Address
First Line	:	3024 E EMPIRE ST FL 2
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704
Country	:	US
Telephone Number	:	309-556-7800
Fax Number	:	309-556-7804

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	05/30/2018

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