Provider Demographics
NPI:1598788473
Name:MARTIN, SHERYL ANNE (BS CSAC)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BS CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4832
Mailing Address - Country:US
Mailing Address - Phone:262-420-9088
Mailing Address - Fax:
Practice Address - Street 1:255 W BROADWAY
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4832
Practice Address - Country:US
Practice Address - Phone:262-420-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI914 132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39170700Medicaid