Provider Demographics
NPI:1912201856
Name:COOPER, SHERI LYNN (MS CLL-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:MS CLL-SLP
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:LYNN
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CLL-SLP
Mailing Address - Street 1:1606 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-2780
Mailing Address - Country:US
Mailing Address - Phone:812-238-7362
Mailing Address - Fax:
Practice Address - Street 1:1606 N 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2780
Practice Address - Country:US
Practice Address - Phone:812-238-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004364A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22004364AOtherSTATE LICENSE NUMBER