Provider Demographics
NPI:1891511739
Name:HERROD, SHARETHA
Entity type:Individual
Prefix:
First Name:SHARETHA
Middle Name:
Last Name:HERROD
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 1:19150 KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4375
Mailing Address - Country:US
Mailing Address - Phone:312-478-8467
Mailing Address - Fax:312-284-2375
Practice Address - Street 1:19150 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-4375
Practice Address - Country:US
Practice Address - Phone:312-478-8467
Practice Address - Fax:312-284-2375
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician