Provider Demographics
NPI:1225279003
Name:DYSVICK, SHERYL L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:L
Last Name:DYSVICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6604 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64126-2208
Mailing Address - Country:US
Mailing Address - Phone:816-483-9927
Mailing Address - Fax:816-483-9934
Practice Address - Street 1:6604 E 12TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64126-2208
Practice Address - Country:US
Practice Address - Phone:816-483-9927
Practice Address - Fax:816-483-9934
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020032491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical