Provider Demographics
NPI:1093567661
Name:HAAS, SHERRY MARIE
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:MARIE
Last Name:HAAS
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 1:1108 W CEDAR ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-1001
Mailing Address - Country:US
Mailing Address - Phone:605-760-5141
Mailing Address - Fax:
Practice Address - Street 1:1108 W CEDAR ST STE 3
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004-1001
Practice Address - Country:US
Practice Address - Phone:605-760-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11844225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist