Provider Demographics
NPI:1598163032
Name:MCDONELL, SHERRY
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:
Last Name:MCDONELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ALPINE ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7330
Mailing Address - Country:US
Mailing Address - Phone:563-557-8283
Mailing Address - Fax:
Practice Address - Street 1:799 MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6844
Practice Address - Country:US
Practice Address - Phone:563-582-3784
Practice Address - Fax:563-582-4006
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA96089101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)