Provider Demographics
NPI:1750575957
Name:SCOTT, SHERI JEAN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:JEAN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 E SOUTHDOWNS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-6058
Mailing Address - Country:US
Mailing Address - Phone:812-219-4418
Mailing Address - Fax:
Practice Address - Street 1:1805 E SOUTHDOWNS DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-6058
Practice Address - Country:US
Practice Address - Phone:812-219-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002373A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200838750Medicaid
IN22002373AOtherIPLA LICENSE
IN01077128OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION