Healthcare Provider Details

I. General information

NPI: 1285343616
Provider Name (Legal Business Name): SHARETHA J. COLE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 N MILL ST STE F
NAPERVILLE IL
60563-4872
US

IV. Provider business mailing address

1813 N MILL ST STE F
NAPERVILLE IL
60563-4872
US

V. Phone/Fax

Practice location:
  • Phone: 630-788-3614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.105672
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: