Healthcare Provider Details

I. General information

NPI: 1255643896
Provider Name (Legal Business Name): SHERRIE D. ALL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 2029
CHICAGO IL
60602-3611
US

IV. Provider business mailing address

30 N MICHIGAN AVE STE 2029
CHICAGO IL
60602-3611
US

V. Phone/Fax

Practice location:
  • Phone: 773-345-3495
  • Fax: 877-259-2359
Mailing address:
  • Phone: 773-345-3495
  • Fax: 877-259-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007929
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071007929
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number071007929
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071007929
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number071007929
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: