Provider Demographics
NPI:1497839872
Name:DOLEZAL, SHERYL L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:L
Last Name:DOLEZAL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:MS
Other - First Name:SHERYL
Other - Middle Name:L
Other - Last Name:GONN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CILSW
Mailing Address - Street 1:5555 N PORT WASHINGTON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4928
Mailing Address - Country:US
Mailing Address - Phone:414-962-6764
Mailing Address - Fax:414-962-6765
Practice Address - Street 1:5555 N PORT WASHINGTON RD STE 300
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-4928
Practice Address - Country:US
Practice Address - Phone:414-962-6764
Practice Address - Fax:414-962-6765
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2353057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39782700Medicaid