Provider Demographics
NPI:1801114731
Name:PRUETT, SHERRY ANN (PLPC)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:ANN
Last Name:PRUETT
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 MADISON 404
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-8116
Mailing Address - Country:US
Mailing Address - Phone:573-783-8954
Mailing Address - Fax:573-783-4409
Practice Address - Street 1:1800 MADISON 257
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-8273
Practice Address - Country:US
Practice Address - Phone:573-783-4400
Practice Address - Fax:573-783-4409
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010012821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional