Provider Demographics
NPI:1982244091
Name:GREEN, SHERRY L (MA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W ALGONQUIN RD UNIT 7575
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-1026
Mailing Address - Country:US
Mailing Address - Phone:847-458-4800
Mailing Address - Fax:
Practice Address - Street 1:1900 E GOLF RD STE 950
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5034
Practice Address - Country:US
Practice Address - Phone:331-214-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178010919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional