Provider Demographics
NPI:1407199136
Name:LAUGHLIN, SHERRY ANN (DT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 N RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-2117
Mailing Address - Country:US
Mailing Address - Phone:773-612-2282
Mailing Address - Fax:773-486-8042
Practice Address - Street 1:1529 N RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-2117
Practice Address - Country:US
Practice Address - Phone:773-612-2282
Practice Address - Fax:773-486-8042
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist