Provider Demographics
NPI:1386477974
Name:DOCK, SHEILA MARIE (LSW)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:DOCK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 RIDGEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5027
Mailing Address - Country:US
Mailing Address - Phone:779-537-0704
Mailing Address - Fax:
Practice Address - Street 1:328 RIDGEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5027
Practice Address - Country:US
Practice Address - Phone:779-537-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150150.1084741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical