Provider Demographics
NPI:1316163991
Name:DECELLE, SHARON ANN (PT, LPC)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ANN
Last Name:DECELLE
Suffix:
Gender:F
Credentials:PT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-6731
Mailing Address - Country:US
Mailing Address - Phone:217-365-0330
Mailing Address - Fax:
Practice Address - Street 1:309 E HOLMES ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-6731
Practice Address - Country:US
Practice Address - Phone:217-403-9938
Practice Address - Fax:217-403-9938
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009488101YP2500X
IL070009964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
113326OtherHEALTHLINK PROV ID
7216OtherPERSONALCARE PROV ID
IL202OtherBLUE CROSS PROV ID
IL4117OtherHAMP PROVIDER ID
113326OtherHEALTHLINK PROV ID