=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952484248
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON ANN FRIEDMAN PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 02/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 645 MCHENRY AVE
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60098-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-337-1234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6809 COLONEL HOLCUMB DR
-----------------------------------------------------
City | CRYSTAL LAKE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-274-3910
-----------------------------------------------------
Fax | 847-934-1550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 071005534
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------