MEDICARE: DR. DONALD ELMORE SHERWOOD PSYD CLINICAL PSYCH

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	103TC0700X	Clinical Psychologist		IL

General Provider Information

NPI Number	:	1497819551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD ELMORE SHERWOOD PSYD CLINICAL PSYCH

Provider Business Mailing Address
First Line	:	37528 NORTH AVE
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60087-2345
Country	:	US
Telephone Number	:	847-623-8866
Fax Number	:	847-625-8836

Provider Business Practice Location Address
First Line	:	37512 NORTH AVE
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60087-2345
Country	:	US
Telephone Number	:	847-623-8866
Fax Number	:	847-625-8836

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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