Provider Demographics
NPI:1003512823
Name:SHERROD, MARYELLEN
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:SHERROD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 MCKINNEY LOOP
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-5147
Mailing Address - Country:US
Mailing Address - Phone:512-785-2216
Mailing Address - Fax:
Practice Address - Street 1:1006 MCKINNEY LOOP
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-5147
Practice Address - Country:US
Practice Address - Phone:512-785-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist