Provider Demographics
NPI:1942265723
Name:DILLARD, SHERRILL L (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHERRILL
Middle Name:L
Last Name:DILLARD
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 1:51826 N MOCKINGBIRD TRL
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1586
Mailing Address - Country:US
Mailing Address - Phone:480-688-0119
Mailing Address - Fax:
Practice Address - Street 1:51826 N MOCKINGBIRD TRL
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1586
Practice Address - Country:US
Practice Address - Phone:480-688-0119
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-20521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR10585Medicare UPIN