Provider Demographics
NPI:1356708283
Name:POWELL, SHERREE (MS)
Entity type:Individual
Prefix:MS
First Name:SHERREE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23526 VIA BARRA
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2625
Mailing Address - Country:US
Mailing Address - Phone:661-414-6765
Mailing Address - Fax:
Practice Address - Street 1:650 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3884
Practice Address - Country:US
Practice Address - Phone:661-272-6898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist