Individual
DR. SHERRIE CECILE GODBOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
15475 S PARK AVE, SUITE 111, SOUTH HOLLAND, IL 60473-1328
(708) 362-5084
(708) 596-6985
Mailing address
15475 S PARK AVE, SUITE 111, SOUTH HOLLAND, IL 60473-1328
(708) 362-5084
(708) 596-6985
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01048641A
IN
2084P0800X
Psychiatry Physician
Primary
036098066
IL
2084P0805X
Geriatric Psychiatry Physician
01048641A
IN
2084P0805X
Geriatric Psychiatry Physician
036098066
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01625468
BCBS PROVIDER ID
IL
05
—
036098066
—
IL
05
—
200197180
—
IN
Enumeration date
09/23/2006
Last updated
01/14/2013
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