Provider Demographics
NPI:1609044189
Name:PEARL, SHARON K (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:K
Last Name:PEARL
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BARCLAY PAVILION E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2161
Mailing Address - Country:US
Mailing Address - Phone:856-429-1505
Mailing Address - Fax:856-429-0942
Practice Address - Street 1:18 BARCLAY PAVILION E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2161
Practice Address - Country:US
Practice Address - Phone:856-429-1505
Practice Address - Fax:856-429-0942
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00079200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
35098OtherAETNA US HEALTHCARE