Provider Demographics
NPI:1265941934
Name:GUAJARDO, SHERI LYNN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:LYNN
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:SHERI
Other - Middle Name:LYNN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3341 N ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3247
Mailing Address - Country:US
Mailing Address - Phone:773-416-6257
Mailing Address - Fax:
Practice Address - Street 1:212 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2692
Practice Address - Country:US
Practice Address - Phone:630-766-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist