Provider Demographics
NPI:1700164571
Name:BROOKS, SHERRY LEE (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2174 ARMAN ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-7012
Mailing Address - Country:US
Mailing Address - Phone:910-333-7254
Mailing Address - Fax:
Practice Address - Street 1:2174 ARMAN ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-7012
Practice Address - Country:US
Practice Address - Phone:910-333-7254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2555235Z00000X
VA2202002841235Z00000X
TX112716235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist