Sherry A Roskam – Marriage & Family Therapist

Key facts

NPI: 1871662973
Entity type: Individual (NPI type 1)
Primary specialty: Marriage & Family Therapist 106H00000X
License: 166000462 (IL)
Practice address: 773 W Lincoln Blvd
Suite 101
Freeport, IL 61032-4976
Phone: (815) 990-8210
Fax: (815) 801-4674
NPI assigned: Nov 6, 2006
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Master of Science

State licenses

License	State	Type	Specialty
166000462	IL	MD	Marriage & Family Therapist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Marriage & Family Therapist	106H00000X	166000462	IL	Yes

Addresses

Primary practice location

773 W Lincoln Blvd
Suite 101
Freeport, IL 61032-4976

Mailing address

773 W Lincoln Blvd
Suite 101
Freeport, IL 61032-6780
Phone (815) 990-8210

Other identifiers

Identifier	Type	State	Issuer
05821971	Other		BCBS
08932004	Other	IL	BCBSIL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 4, 2010.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288828800000",
    "number": "1871662973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "773 W LINCOLN BLVD",
            "address_2": "SUITE 101",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610326780",
            "telephone_number": "815-990-8210",
            "fax_number": "815-801-4674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "773 W LINCOLN BLVD",
            "address_2": "SUITE 101",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610324976",
            "telephone_number": "815-990-8210",
            "fax_number": "815-801-4674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSKAM",
        "first_name": "SHERRY",
        "middle_name": "A",
        "credential": "MS, LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2010-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166000462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "05821971",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL",
            "identifier": "08932004",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeport, IL

All providers in Freeport, IL · Marriage & Family Therapist in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.