Provider Demographics
NPI:1942640891
Name:LUSIAK, SHERRY ANN (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SHERRY
Middle Name:ANN
Last Name:LUSIAK
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 1:801 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-3850
Mailing Address - Country:US
Mailing Address - Phone:401-475-6367
Mailing Address - Fax:401-475-6367
Practice Address - Street 1:801 GREAT RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-3850
Practice Address - Country:US
Practice Address - Phone:401-475-6367
Practice Address - Fax:401-475-6367
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist