Healthcare Provider Details

I. General information

NPI: 1689050643
Provider Name (Legal Business Name): SHERYL LYNN BRAGG CP 60116516
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 CENTER ST
SHELTON WA
98584-1105
US

IV. Provider business mailing address

1511 CENTER ST
SHELTON WA
98584-1105
US

V. Phone/Fax

Practice location:
  • Phone: 360-888-8337
  • Fax:
Mailing address:
  • Phone: 360-888-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number60116516
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: