Provider Demographics
NPI:1306005251
Name:SHEROAN, HOLLY SAMANTHA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:SAMANTHA
Last Name:SHEROAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:VINE GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:40175-1020
Mailing Address - Country:US
Mailing Address - Phone:270-317-3801
Mailing Address - Fax:270-877-7237
Practice Address - Street 1:922 HICKORY DR
Practice Address - Street 2:
Practice Address - City:VINE GROVE
Practice Address - State:KY
Practice Address - Zip Code:40175-1020
Practice Address - Country:US
Practice Address - Phone:270-317-3801
Practice Address - Fax:270-877-7237
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12135034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist