Provider Demographics
NPI:1053525881
Name:ROSENGARD-MIRANDA, SHERI (BSC, LMT, NCTMB)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:
Last Name:ROSENGARD-MIRANDA
Suffix:
Gender:F
Credentials:BSC, LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 TOWNE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERTS
Mailing Address - State:IL
Mailing Address - Zip Code:60136-9017
Mailing Address - Country:US
Mailing Address - Phone:847-836-8886
Mailing Address - Fax:847-836-8887
Practice Address - Street 1:1141 E MAIN ST
Practice Address - Street 2:SUITE 213
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2440
Practice Address - Country:US
Practice Address - Phone:847-836-8886
Practice Address - Fax:847-836-8887
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist