Provider Demographics
NPI:1730380742
Name:DIGIACOMO, SHARON VOGT (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:VOGT
Last Name:DIGIACOMO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 PERIWINKLE TURN
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1871
Mailing Address - Country:US
Mailing Address - Phone:815-932-8443
Mailing Address - Fax:815-936-1295
Practice Address - Street 1:735 PERIWINKLE TURN
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1871
Practice Address - Country:US
Practice Address - Phone:815-932-8443
Practice Address - Fax:815-936-1295
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent