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Contact Information

SHERRIE C GODBOLT, MD
15475 S PARK AVE
SUITE 111
SOUTH HOLLAND, IL60473-1328
 Phone: 708-362-5084
 Fax: 708-596-6985
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Geriatric Psychiatry

2084P0805X 86 Physician/Neuropsychiatry
Indicates primary specialty

NPI Profile & details for SHERRIE C GODBOLT · (Female)

NPI Number 1114027828
Status Active
Credentials MD
Entity Individual
Enumeration date 09/23/2006
Last updated 01/14/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 036098066
  • IN License # 01048641A
  • IL Medicaid 036098066
  • IN Medicaid 200197180
  • IL Other 01625468 BCBS PROVIDER ID
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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