Provider Demographics
NPI:1710203443
Name:LONCZAK, SHERRI ELLEN (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:ELLEN
Last Name:LONCZAK
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 READ ST
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-1413
Mailing Address - Country:US
Mailing Address - Phone:508-336-6749
Mailing Address - Fax:
Practice Address - Street 1:560 READ ST
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-1413
Practice Address - Country:US
Practice Address - Phone:508-336-6749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMTN982074250OtherBLUECROSS BLUESHIELD