Provider Demographics
NPI:1841292133
Name:HODGE, SHERRY LYNNE (AUD)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LYNNE
Last Name:HODGE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 N MADISON AVE
Mailing Address - Street 2:STE C
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-2148
Mailing Address - Country:US
Mailing Address - Phone:765-608-3277
Mailing Address - Fax:765-608-3278
Practice Address - Street 1:1827 N MADISON AVE
Practice Address - Street 2:STE C
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-2148
Practice Address - Country:US
Practice Address - Phone:765-608-3277
Practice Address - Fax:765-608-3278
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001704A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000227627OtherANTHEM
IN200326790Medicaid
IN200326790Medicaid
IN000000227627OtherANTHEM