Provider Demographics
NPI:1366580144
Name:SHERMAN, JACQUELINE BELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:BELLE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2718
Mailing Address - Country:US
Mailing Address - Phone:406-350-1807
Mailing Address - Fax:406-535-6450
Practice Address - Street 1:207 W MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2718
Practice Address - Country:US
Practice Address - Phone:406-350-1807
Practice Address - Fax:406-535-6450
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0491402Medicaid
MT52371OtherBLUE CROSS BLUE SHIELD OF
MT0491402Medicaid