Provider Demographics
NPI:1114940533
Name:BROKAW, SHERRI CARROLL (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:CARROLL
Last Name:BROKAW
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 1:174 LAKE SHEPARD DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1636
Mailing Address - Country:US
Mailing Address - Phone:407-435-0186
Mailing Address - Fax:
Practice Address - Street 1:174 LAKE SHEPARD DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-1636
Practice Address - Country:US
Practice Address - Phone:407-435-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist