Provider Demographics
NPI:1336409440
Name:BAUDENDISTEL, SHERYL LYNN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:LYNN
Last Name:BAUDENDISTEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14962 AKRON CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-5659
Mailing Address - Country:US
Mailing Address - Phone:303-654-0736
Mailing Address - Fax:
Practice Address - Street 1:14962 AKRON CT
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80602-5659
Practice Address - Country:US
Practice Address - Phone:303-654-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09116960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist