Provider Demographics
NPI:1114949070
Name:STREET-TOBIN, SHERRY L (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:STREET-TOBIN
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 STONEY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-9385
Mailing Address - Country:US
Mailing Address - Phone:828-773-6133
Mailing Address - Fax:
Practice Address - Street 1:1620 STONEY BROOK LN
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-9385
Practice Address - Country:US
Practice Address - Phone:828-773-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2541235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411024Medicaid
NC13478OtherBLUE CROSS BS OF NC