Healthcare Provider Details

I. General information

NPI: 1164776175
Provider Name (Legal Business Name): SHERRIE D ALL, PHD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
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: 855-264-9355
  • Fax: 855-792-0240
Mailing address:
  • Phone: 855-264-9355
  • Fax: 855-792-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071007929
License Number StateIL

VIII. Authorized Official

Name: SHERRIE D ALL
Title or Position: OWNER
Credential: PHD
Phone: 855-264-9355