Provider Demographics
NPI:1710369533
Name:SHERRILL, MARTHA HAWKINS (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:HAWKINS
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5443
Mailing Address - Country:US
Mailing Address - Phone:985-688-1923
Mailing Address - Fax:
Practice Address - Street 1:1000 JASON WITTEN WAY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2970
Practice Address - Country:US
Practice Address - Phone:423-439-4355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ087383Medicaid