Provider Demographics
NPI:1952493207
Name:SHERWOOD, JAMES ROSWELL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROSWELL
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5545 RUSH ROAD
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54519-9236
Mailing Address - Country:US
Mailing Address - Phone:715-477-2962
Mailing Address - Fax:
Practice Address - Street 1:5545 RUSH ROAD
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:WI
Practice Address - Zip Code:54519-9236
Practice Address - Country:US
Practice Address - Phone:715-477-2962
Practice Address - Fax:715-369-4577
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6696-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39790100Medicaid