Provider Demographics
NPI:1407232242
Name:MADDOX, SHERRY J (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:J
Last Name:MADDOX
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 1:1415 MORTON STREET
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355
Mailing Address - Country:US
Mailing Address - Phone:402-245-2825
Mailing Address - Fax:
Practice Address - Street 1:1415 MORTON STREET
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355
Practice Address - Country:US
Practice Address - Phone:402-245-2825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE520235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist