Provider Demographics
NPI:1346574399
Name:SCHERMERHORN, MARK CHARLES (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:SCHERMERHORN
Suffix:
Gender:M
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:PO BOX 457
Mailing Address - Street 2:SAGE MEMORIAL HOSPITAL
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505
Mailing Address - Country:US
Mailing Address - Phone:928-755-4566
Mailing Address - Fax:928-755-4567
Practice Address - Street 1:SAGE MEMORIAL HOSPITAL
Practice Address - Street 2:HWY 264
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505
Practice Address - Country:US
Practice Address - Phone:928-755-4566
Practice Address - Fax:928-755-4567
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist