Provider Demographics
NPI:1134306848
Name:GLENN, SHERRI A
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:A
Last Name:GLENN
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 1:1674 SUNCHASE DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3082
Mailing Address - Country:US
Mailing Address - Phone:660-438-6387
Mailing Address - Fax:
Practice Address - Street 1:23395 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:MO
Practice Address - Zip Code:65326-3348
Practice Address - Country:US
Practice Address - Phone:660-438-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111567235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist