MEDICARE: LISA SHERRY IMHOFF LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	15326-132	WI
2	1041C0700X	Clinical Social Worker	7910-123	WI
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	126852	WI

General Provider Information

NPI Number	:	1275826620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SHERRY IMHOFF LCSW

Provider Business Mailing Address
First Line	:	1001 N WINGRA DR # MC2433
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53715-1933
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 HILL ST STE 260B
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-3572
Country	:	US
Telephone Number	:	608-628-7229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	07/09/2019

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