Provider Demographics
NPI:1417192253
Name:SMITH, SHERRI L (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 STARGRASS RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8935
Mailing Address - Country:US
Mailing Address - Phone:417-582-1878
Mailing Address - Fax:
Practice Address - Street 1:3111 HIGHWAY A
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MO
Practice Address - Zip Code:65704-8105
Practice Address - Country:US
Practice Address - Phone:417-924-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist