Provider Demographics
NPI:1720536303
Name:ELLIOTT, SHERRY (SLP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12880 NE 10
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8129
Mailing Address - Country:US
Mailing Address - Phone:405-769-8389
Mailing Address - Fax:
Practice Address - Street 1:12880 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8129
Practice Address - Country:US
Practice Address - Phone:405-769-8389
Practice Address - Fax:405-769-9821
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist