Provider Demographics
NPI:1467664953
Name:GADDIS, SHERRY D
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:D
Last Name:GADDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SHERRY
Other - Middle Name:D
Other - Last Name:WELDELE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:610 S. PARK CREST DR.
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-7802
Mailing Address - Country:US
Mailing Address - Phone:815-233-3277
Mailing Address - Fax:815-232-2268
Practice Address - Street 1:610 S. PARK CREST DR.
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-7802
Practice Address - Country:US
Practice Address - Phone:815-233-3277
Practice Address - Fax:815-232-2268
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK16551Medicare ID - Type Unspecified
ILPIN211438Medicare UPIN