Provider Demographics
NPI:1982403465
Name:THOMPSON, SHERRY DENISE
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:DENISE
Last Name:THOMPSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 N WOODBINE TER
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-1127
Mailing Address - Country:US
Mailing Address - Phone:309-363-4449
Mailing Address - Fax:
Practice Address - Street 1:3509 N WOODBINE TER
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-1127
Practice Address - Country:US
Practice Address - Phone:309-363-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150013477104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker