DR. KELLY JANE SHERACK (NPI# 1639261688) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639261688 |
| Entity Type | Individual |
| Full Name | DR. KELLY JANE SHERACK |
| Credential | PHD, MA |
| Practice Address |
2656 W Montrose Ave Suite #106 Chicago IL 60618-1559 |
| Practice Telephone | 7734157147 |
| Practice Fax Number | 7734097157 |
| Mailing Telephone | 7734157147 |
| Mailing Fax Number | 7734097157 |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC1900X |
Psychologist Specialization: Counseling |
IL | Behavioral Health & Social Service Providers |
| Street Address |
2656 W MONTROSE AVE SUITE #106 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60618-1559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033162227 | David L. Lynn | Psychologist | 2656 W Montrose Ave, Suite 101, Chicago, IL 60618-1559 | 2006-05-18 |
| 1841646015 | Shayla Brianne Martinez | Counselor | 2656 W Montrose Ave, Chicago, IL 60618-1559 | 2016-05-06 |
| 1861846032 | Comprehensive Home Services Inc | In Home Supportive Care | 2656 W Montrose Ave, Suite 106, Chicago, IL 60618-1559 | 2016-04-14 |
| 1427417864 | Rebecca J Koeppen | Counselor | 2656 W Montrose Ave, Chicago, IL 60618-1559 | 2016-02-13 |
| 1609232032 | Raquel Flores | Social Worker | 2656 W Montrose Ave, Chicago, IL 60618-1559 | 2016-01-14 |
| 1902216849 | James Boggess | Social Worker | 2656 W Montrose Ave, Chicago, IL 60618-1559 | 2014-04-30 |
| 1871912006 | Carla Fincher | Social Worker | 2656 W Montrose Ave, Chicago, IL 60618-1559 | 2014-04-15 |
| 1053740373 | Monique A. Smith | Social Worker | 2656 W Montrose Ave, Chicago, IL 60618-1559 | 2013-11-06 |
| 1336576826 | Kolleen Blume | Counselor | 2656 W Montrose Ave, Chicago, IL 60618-1559 | 2013-09-30 |
| 1790021327 | Catharine Devlin, Psyd, Sc | Psychologist | 2656 W Montrose Ave, Suite 104, Chicago, IL 60618-1559 | 2012-12-31 |
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| 1528540986 | Ruby Erdmann | Dietitian, Registered | 3126 N Kimball Ave. #3w, Chicago, IL 60618 | 2018-09-02 |
| 1962997064 | Living Roots Psychotherapy, LLC | Clinic/Center | 4310 N Spaulding Ave, Chicago, IL 60618 | 2018-06-30 |
| 1962920116 | Alif Muhammad | Counselor | 3819 W Cornelia Ave #2, Chicago, IL 60618 | 2017-09-07 |
| 1417471178 | Daniel Lee Mcmillan | Counselor | 3433 N. Ridgeway Ave, Apt G, Chicago, IL 60618 | 2017-08-03 |
| 1508380486 | Callie Weinberg | Social Worker | 2945 N Damen Ave, 1s, Chicago, IL 60618 | 2017-08-01 |
| 1275062697 | Melissa Ann Prest | Dietitian, Registered | 3258 W Warner Ave, Apt 2, Chicago, IL 60618 | 2017-06-08 |
| 1871951038 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 4315 N. Lincoln Avenue, Chicago, IL 60618 | 2016-02-03 |
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| Taxonomy Code | 103TC1900X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Counseling |
| Definition to come... |
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| 1710217310 | Christina Samycia | Psychologist | 77 W Washington St Ste 1519, Chicago, IL 60602-3223 | 2010-01-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.