Provider Demographics
NPI:1578811410
Name:PANCOST, SHERRY (MA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:PANCOST
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 1:714 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-4568
Mailing Address - Country:US
Mailing Address - Phone:269-979-3881
Mailing Address - Fax:269-979-2841
Practice Address - Street 1:714 MAIN ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-4568
Practice Address - Country:US
Practice Address - Phone:269-979-3881
Practice Address - Fax:269-979-2841
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014755103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily