Provider Demographics
NPI:1437342565
Name:SHERWOOD, EMILY WALKER (MA)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:WALKER
Last Name:SHERWOOD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5705
Mailing Address - Country:US
Mailing Address - Phone:269-349-7943
Mailing Address - Fax:
Practice Address - Street 1:1604 TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5705
Practice Address - Country:US
Practice Address - Phone:269-349-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008445103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301008445OtherCATHOLIC FAMILY SERVICES