Provider Demographics
NPI:1447595160
Name:KRGA, SHARON LYNN (DT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LYNN
Last Name:KRGA
Suffix:
Gender:F
Credentials:DT
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:LYNN
Other - Last Name:KRGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DT
Mailing Address - Street 1:10523 S HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2513
Mailing Address - Country:US
Mailing Address - Phone:773-620-2014
Mailing Address - Fax:
Practice Address - Street 1:10523 S HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2513
Practice Address - Country:US
Practice Address - Phone:773-620-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist