Sheryl L Dolezal, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2353057 Issued in WI

Practice address

5555 N Port Washington Rd Ste 300
Milwaukee, WI 53217-4928

Phone

(414) 962-6764

Fax

(414) 962-6765

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Sheryl L Gonn Other name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2000

Medicare assignment

May accept Medicare assignment

Group practices

North Shore Psychotherapy Associates IVGroup PAC ID 7911287461, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Shore Psychotherapy Associates IV

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Glendale, WI
  • NPI 1194809574

  Clinical

  Medicare reassignment Care Compare group NPD Authorized official
• Wisconsin School of Professional Psychology

  • Psychologist
  • Milwaukee, WI
  • NPI 1902011257
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1497839872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 N PORT WASHINGTON RD STE 300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174928",
            "telephone_number": "414-962-6764",
            "fax_number": "414-962-6765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 N PORT WASHINGTON RD STE 300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174928",
            "telephone_number": "414-962-6764",
            "fax_number": "414-962-6765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLEZAL",
        "first_name": "SHERYL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2353057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39782700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHERYL",
            "last_name": "GONN",
            "middle_name": "L",
            "prefix": "MS.",
            "credential": "CILSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Abdi Bashir Dolal
• Ann M Dolan, LCSW
• Joshua James Dolan, PH.D.
• Lindsay Dolan, PT, DPT
• Stephen Dolan, MD
• Patricia J. Dolhun, M.D.
• Sylvia Y Dolinski, MD
• Patrick Paul Dolinsky, RN
• Marilyn Margaret Doll-Rayner, NP
• Laura Doll

• Clinical Psychologist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.