Provider Demographics
NPI:1164776175
Name:SHERRIE D ALL, PHD, PC
Entity Type:Organization
Organization Name:SHERRIE D ALL, PHD, PC
Other - Org Name:CENTERS FOR COGNITIVE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:855-264-9355
Mailing Address - Street 1:30 N MICHIGAN AVE STE 2029
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3611
Mailing Address - Country:US
Mailing Address - Phone:855-264-9355
Mailing Address - Fax:855-792-0240
Practice Address - Street 1:30 N MICHIGAN AVE STE 2029
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3611
Practice Address - Country:US
Practice Address - Phone:855-264-9355
Practice Address - Fax:855-792-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007929103G00000X
261QM0801X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty