Provider Demographics
NPI:1891391561
Name:WADSWORTH, SHERILYN D (PPS)
Entity Type:Individual
Prefix:
First Name:SHERILYN
Middle Name:D
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33550 N DOVE LAKES DR UNIT 1041
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4542
Mailing Address - Country:US
Mailing Address - Phone:707-367-2044
Mailing Address - Fax:
Practice Address - Street 1:33550 N DOVE LAKES DR UNIT 1041
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-4542
Practice Address - Country:US
Practice Address - Phone:707-367-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220067373101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty