Provider Demographics
NPI:1619413176
Name:SHERROD, DAWN (MSW, CRAADC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:SHERROD
Suffix:
Gender:F
Credentials:MSW, CRAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4049A BOTANICAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3905
Mailing Address - Country:US
Mailing Address - Phone:314-308-6278
Mailing Address - Fax:
Practice Address - Street 1:4130 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2914
Practice Address - Country:US
Practice Address - Phone:314-535-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)