Healthcare Provider Details

I. General information

NPI: 1760405401
Provider Name (Legal Business Name): SHARON J. KLINGMAN MS, CADC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 E EMPIRE ST FL 2
BLOOMINGTON IL
61704
US

IV. Provider business mailing address

PO BOX 2451
BLOOMINGTON IL
61702-2451
US

V. Phone/Fax

Practice location:
  • Phone: 309-556-7800
  • Fax: 309-556-7804
Mailing address:
  • Phone: 309-268-2172
  • Fax: 309-268-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number180000652
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180000652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: