Provider Demographics
NPI:1497505242
Name:SHERIDAN, EMILY (JD MSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:JD MSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6491 KODIAK DR SE
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:MI
Mailing Address - Zip Code:49302-9080
Mailing Address - Country:US
Mailing Address - Phone:616-648-6493
Mailing Address - Fax:
Practice Address - Street 1:118 S GREENVILLE WEST DR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-3554
Practice Address - Country:US
Practice Address - Phone:616-805-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511178811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical