Provider Demographics
NPI:1437315280
Name:JOHNSON, SHERI L (PHD)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:L
Other - Last Name:PATTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5433 W FOND DU LAC AVE
Mailing Address - Street 2:MIDTOWN PEDIATRICS
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1382
Mailing Address - Country:US
Mailing Address - Phone:414-277-8900
Mailing Address - Fax:414-277-8939
Practice Address - Street 1:5433 W FOND DU LAC AVE
Practice Address - Street 2:MIDTOWN PEDIATRICS
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1382
Practice Address - Country:US
Practice Address - Phone:414-277-8900
Practice Address - Fax:414-277-8939
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1910103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1437315280Medicaid
WI39124800Medicaid
WI68086 0779Medicare PIN
WI39124800Medicaid