Provider Demographics
NPI:1124392816
Name:WARD, SHERRY LYNN (LPC, CSAC RN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:WARD
Suffix:
Gender:F
Credentials:LPC, CSAC RN
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:LYNN
Other - Last Name:LEVENHAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-0516
Mailing Address - Country:US
Mailing Address - Phone:262-210-3034
Mailing Address - Fax:
Practice Address - Street 1:125 E STATE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1915
Practice Address - Country:US
Practice Address - Phone:262-767-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7692-125101YM0800X
WI68922-30163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health