Provider Demographics
NPI:1255590980
Name:BIRCH, SHERRY W (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:W
Last Name:BIRCH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29991 N 122ND DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3457
Mailing Address - Country:US
Mailing Address - Phone:406-581-3313
Mailing Address - Fax:
Practice Address - Street 1:111 E DUNLAP AVE
Practice Address - Street 2:# 1-125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2807
Practice Address - Country:US
Practice Address - Phone:406-581-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1201235Z00000X
AZSLP4640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist