Provider Demographics
NPI:1073642286
Name:SHERMAN, LEANN (SLP)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17105 SE TINNEY RD
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572-8216
Mailing Address - Country:US
Mailing Address - Phone:580-248-2328
Mailing Address - Fax:580-248-2329
Practice Address - Street 1:17105 SE TINNEY RD
Practice Address - Street 2:
Practice Address - City:WALTERS
Practice Address - State:OK
Practice Address - Zip Code:73572-8216
Practice Address - Country:US
Practice Address - Phone:580-248-2328
Practice Address - Fax:580-248-2329
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist