Provider Demographics
NPI:1235443722
Name:SHERRETTA, CARRIE LYNN (MACCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYNN
Last Name:SHERRETTA
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:HIRSCHHORN
Other - Last Name:SHERRETTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:2229 PANAMA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6525
Mailing Address - Country:US
Mailing Address - Phone:215-732-4006
Mailing Address - Fax:
Practice Address - Street 1:2229 PANAMA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6525
Practice Address - Country:US
Practice Address - Phone:215-732-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003092L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist