MEDICARE: SHERI L GOLDEN

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	101YM0800X	Mental Health Counselor	178.00612	IL

General Provider Information

NPI Number	:	1861960171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERI L GOLDEN

Provider Business Mailing Address
First Line	:	PO BOX 607111
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-7111
Country	:	US
Telephone Number	:	773-850-1417
Fax Number	:

Provider Business Practice Location Address
First Line	:	6245 N LOWELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5003
Country	:	US
Telephone Number	:	773-835-1279
Fax Number	:

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

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	11/05/2018

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Directions to “ SHERI L GOLDEN ” Practice Location

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