Provider Demographics
NPI:1821235383
Name:ANDERSON, SHERYLL ANN (SOCIAL WORKER)
Entity Type:Individual
Prefix:MS
First Name:SHERYLL
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WHITE BIRCH
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9052
Mailing Address - Country:US
Mailing Address - Phone:608-334-2494
Mailing Address - Fax:
Practice Address - Street 1:708 ELIZABETH ST
Practice Address - Street 2:INNERVISIONS COUNSELING CENTER
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9052
Practice Address - Country:US
Practice Address - Phone:608-356-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1911-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker