Provider Demographics
NPI:1740309699
Name:DEAN, SHERYL ANN (LCSW,BSW,CSAC,RCS)
Entity type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:ANN
Last Name:DEAN
Suffix:
Gender:F
Credentials:LCSW,BSW,CSAC,RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2159
Mailing Address - Country:US
Mailing Address - Phone:414-874-2560
Mailing Address - Fax:414-874-2565
Practice Address - Street 1:4810 NORTHWESTERN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-1504
Practice Address - Country:US
Practice Address - Phone:262-634-9984
Practice Address - Fax:262-637-9995
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14349-131101YA0400X
WI9650-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39175200Medicaid