Provider Demographics
NPI:1114201258
Name:MICHEL, SHERRY MAEBETHRINE (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:MAEBETHRINE
Last Name:MICHEL
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:SHERRY 'KATE'
Other - Middle Name:MAEBETHRINE
Other - Last Name:GRAZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1707 JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1837
Mailing Address - Country:US
Mailing Address - Phone:309-750-2649
Mailing Address - Fax:
Practice Address - Street 1:1707 JONES BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1837
Practice Address - Country:US
Practice Address - Phone:309-750-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist