Basic Information
| Provider Information | |||||||||
| NPI: | 1164776175 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHERRIE D ALL, PHD, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHICAGO CENTER FOR COGNITIVE WELLNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6033 N SHERIDAN RD STE S7 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606603013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552649355 | ||||||||
| FaxNumber: | 7739899300 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 N MICHIGAN AVE STE 1621 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606023669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552649355 | ||||||||
| FaxNumber: | 8557920240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2012 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALL | ||||||||
| AuthorizedOfficialFirstName: | SHERRIE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8552649355 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 103G00000X | 071007929 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.