Provider Demographics
NPI:1821000803
Name:MOLBURG, SHERRY LEE (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:LEE
Last Name:MOLBURG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 W TIMBER RIDGE DR
Mailing Address - Street 2:APT. 2
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2071
Mailing Address - Country:US
Mailing Address - Phone:309-692-2087
Mailing Address - Fax:
Practice Address - Street 1:411 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2400
Practice Address - Country:US
Practice Address - Phone:309-497-0790
Practice Address - Fax:309-497-3564
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical