Provider Demographics
NPI:1326259011
Name:DOYLE, SHERRY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:L
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:955 WATER ST STE C
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-3455
Mailing Address - Country:US
Mailing Address - Phone:870-612-1716
Mailing Address - Fax:870-612-1718
Practice Address - Street 1:955 WATER ST STE C
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3455
Practice Address - Country:US
Practice Address - Phone:870-612-1716
Practice Address - Fax:870-612-1718
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP #1577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR228799721Medicaid
12008605OtherASHA-CERTIFICATION MEMBER
ARSP #1577OtherABESPA LICENSURE NUMBER