Provider Demographics
NPI:1649691973
Name:KATZMAN, SHERRY (SLP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:KATZMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 POWDER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1919
Mailing Address - Country:US
Mailing Address - Phone:618-397-7462
Mailing Address - Fax:
Practice Address - Street 1:102 W SCHUETZ ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IL
Practice Address - Zip Code:62254-1571
Practice Address - Country:US
Practice Address - Phone:618-537-4553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.001899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146.001899OtherLICENSE