Provider Demographics
NPI:1942338603
Name:INGRUM, SHARYN L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHARYN
Middle Name:L
Last Name:INGRUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19015 S JODI RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8514
Mailing Address - Country:US
Mailing Address - Phone:708-479-4007
Mailing Address - Fax:708-479-4073
Practice Address - Street 1:19015 S JODI RD
Practice Address - Street 2:SUITE H
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8514
Practice Address - Country:US
Practice Address - Phone:708-479-4007
Practice Address - Fax:708-479-4073
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health