Provider Demographics
NPI:1558608737
Name:SHOCKEY, SHERYL K (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:K
Last Name:SHOCKEY
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 EL MONTE ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2359
Mailing Address - Country:US
Mailing Address - Phone:913-485-4224
Mailing Address - Fax:
Practice Address - Street 1:12901 EL MONTE ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-2359
Practice Address - Country:US
Practice Address - Phone:913-485-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS536OtherLICENSE IN SPEECH PATHOLOGY
01101602OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
MO2011015237OtherLICENSE IN SPEECH PATHOLOGY