Provider Demographics
NPI:1184845877
Name:SHERICK, IVAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:SHERICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RIVERVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1846
Mailing Address - Country:US
Mailing Address - Phone:734-662-2211
Mailing Address - Fax:
Practice Address - Street 1:220 RIVERVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1846
Practice Address - Country:US
Practice Address - Phone:734-662-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001107102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301001107OtherSTATE LICENSE ID #
MION57350Medicare ID - Type Unspecified