Provider Demographics
NPI:1063686996
Name:GODFREY, SHARON ELIZABETH (CCC, SLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ELIZABETH
Last Name:GODFREY
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 CHARMONT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:AR
Mailing Address - Zip Code:72933-9060
Mailing Address - Country:US
Mailing Address - Phone:479-747-7734
Mailing Address - Fax:
Practice Address - Street 1:1322 CHARMONT DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933-9060
Practice Address - Country:US
Practice Address - Phone:479-649-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2010-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist