Provider Demographics
NPI:1457983793
Name:ANDERSON, SHERRIE LYNN (99097310A LSW)
Entity type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:99097310A LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6180 S WILD SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454-8953
Mailing Address - Country:US
Mailing Address - Phone:812-653-7428
Mailing Address - Fax:
Practice Address - Street 1:420 W LONGEST ST
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-8821
Practice Address - Country:US
Practice Address - Phone:812-723-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99097310A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health