Provider Demographics
NPI:1750653176
Name:MILLER, SHARRIE LYNN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHARRIE
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:SHARRIE
Other - Middle Name:
Other - Last Name:GLATZHOFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 S GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1638
Mailing Address - Country:US
Mailing Address - Phone:618-681-1113
Mailing Address - Fax:
Practice Address - Street 1:400 S GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1638
Practice Address - Country:US
Practice Address - Phone:618-681-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist