Healthcare Provider Details

I. General information

NPI: 1568518132
Provider Name (Legal Business Name): SHERYL ANN WISEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WILLOW PASS RD 200
CONCORD CA
94520-5223
US

IV. Provider business mailing address

148 LILAC CIR
HERCULES CA
94547-1014
US

V. Phone/Fax

Practice location:
  • Phone: 925-646-5480
  • Fax: 925-646-5622
Mailing address:
  • Phone: 510-245-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: