Healthcare Provider Details

I. General information

NPI: 1447164082
Provider Name (Legal Business Name): SHERRELL DONEGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 W 62ND ST
CHICAGO IL
60621-3809
US

IV. Provider business mailing address

5408 S MORGAN ST
CHICAGO IL
60609-6053
US

V. Phone/Fax

Practice location:
  • Phone: 219-384-3339
  • Fax:
Mailing address:
  • Phone: 224-716-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: