Provider Demographics
NPI:1467405118
Name:RESENDEZ, SHERI (AUD)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:RESENDEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 12TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2457
Mailing Address - Country:US
Mailing Address - Phone:360-577-7702
Mailing Address - Fax:360-636-5447
Practice Address - Street 1:843 12TH AVE
Practice Address - Street 2:STE A
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2457
Practice Address - Country:US
Practice Address - Phone:360-577-7702
Practice Address - Fax:360-636-5447
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002587231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8414716Medicaid