Provider Demographics
NPI:1851522791
Name:STAROVASNIK, SHERRY LYNN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:STAROVASNIK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3873 BROOKHURST CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8128
Mailing Address - Country:US
Mailing Address - Phone:678-584-1943
Mailing Address - Fax:
Practice Address - Street 1:11111 HOUZE RD STE 101
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1464
Practice Address - Country:US
Practice Address - Phone:770-998-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist