Provider Demographics
NPI:1851881155
Name:EDDY, SHERRI SUE (HIS 2017040815)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:SUE
Last Name:EDDY
Suffix:
Gender:F
Credentials:HIS 2017040815
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 S APRIL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8180
Mailing Address - Country:US
Mailing Address - Phone:417-766-3452
Mailing Address - Fax:
Practice Address - Street 1:1350 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1160
Practice Address - Country:US
Practice Address - Phone:417-823-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017040815237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist