Provider Demographics
NPI:1629245253
Name:BERTEAUX, SHERRY DAWN
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:DAWN
Last Name:BERTEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:DAWN
Other - Last Name:WARWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC,
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:ILWACO
Mailing Address - State:WA
Mailing Address - Zip Code:98624-0224
Mailing Address - Country:US
Mailing Address - Phone:360-642-8915
Mailing Address - Fax:360-642-8915
Practice Address - Street 1:304 PACIFIC AVE S
Practice Address - Street 2:LONG BEACH
Practice Address - City:WA
Practice Address - State:WA
Practice Address - Zip Code:98631-0224
Practice Address - Country:US
Practice Address - Phone:360-642-8915
Practice Address - Fax:360-642-8915
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health