Provider Demographics
NPI:1922177492
Name:SEIFERT, CHERYL DIANE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DIANE
Last Name:SEIFERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 S PULASKI RD
Mailing Address - Street 2:#9
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4554
Mailing Address - Country:US
Mailing Address - Phone:773-582-1702
Mailing Address - Fax:
Practice Address - Street 1:5935 S PULASKI RD
Practice Address - Street 2:#9
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4554
Practice Address - Country:US
Practice Address - Phone:773-582-1702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31622906OtherBC BS PROVIDER NUMBER