Provider Demographics
NPI:1376184648
Name:BOURGEOIS, SHERRI ANN
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:ANN
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 EASTBRIAR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-9125
Mailing Address - Country:US
Mailing Address - Phone:231-360-9265
Mailing Address - Fax:
Practice Address - Street 1:1520 EASTBRIAR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-9125
Practice Address - Country:US
Practice Address - Phone:231-360-9265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician