Provider Demographics
NPI:1790558153
Name:EMPOWERED NEURODIVERSITY
Entity Type:Organization
Organization Name:EMPOWERED NEURODIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHERROD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-456-1374
Mailing Address - Street 1:4220 GARDENVIEW DR APT 209
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-7166
Mailing Address - Country:US
Mailing Address - Phone:630-765-5740
Mailing Address - Fax:
Practice Address - Street 1:2735 HASSERT BLVD SUITE 135
Practice Address - Street 2:PMB 2175
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564
Practice Address - Country:US
Practice Address - Phone:630-765-5740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)