Provider Demographics
NPI:1437488244
Name:SHERRON, BRIDGETT (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:
Last Name:SHERRON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:BRIDGETT
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 HILL STREAM DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5852
Mailing Address - Country:US
Mailing Address - Phone:202-577-9497
Mailing Address - Fax:
Practice Address - Street 1:900 HILL STREAM DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-5852
Practice Address - Country:US
Practice Address - Phone:202-577-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist