Provider Demographics
NPI:1619783065
Name:TUCKER, SHARI (LCPC)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N BLACKHAWK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61072-2002
Mailing Address - Country:US
Mailing Address - Phone:815-222-6056
Mailing Address - Fax:
Practice Address - Street 1:420 N BLACKHAWK BLVD
Practice Address - Street 2:
Practice Address - City:ROCKTON
Practice Address - State:IL
Practice Address - Zip Code:61072-2002
Practice Address - Country:US
Practice Address - Phone:815-222-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional