Provider Demographics
NPI:1023580578
Name:BLEVINS, SHERRI LEIGH (MS)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:LEIGH
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 KREITLER RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-1011
Mailing Address - Country:US
Mailing Address - Phone:410-207-2469
Mailing Address - Fax:
Practice Address - Street 1:1527 WHITEFORD RD
Practice Address - Street 2:
Practice Address - City:STREET
Practice Address - State:MD
Practice Address - Zip Code:21154-1929
Practice Address - Country:US
Practice Address - Phone:410-638-3703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist