Provider Demographics
NPI:1114660552
Name:HENSLEY, SHERYL ANN (CG61293081)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:CG61293081
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:ANN
Other - Last Name:HAMBLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3202 E MILL PLAIN BLVD APT 7
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-5346
Mailing Address - Country:US
Mailing Address - Phone:360-566-5126
Mailing Address - Fax:
Practice Address - Street 1:5197 NW LOWER RIVER RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660
Practice Address - Country:US
Practice Address - Phone:360-205-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61293081175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist