Provider Demographics
NPI:1194944074
Name:BROOKS, SHERRI (PHD)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 WARRINGTON CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-6531
Mailing Address - Country:US
Mailing Address - Phone:870-897-9092
Mailing Address - Fax:
Practice Address - Street 1:3880 WARRINGTON CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-6531
Practice Address - Country:US
Practice Address - Phone:870-897-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1434235Z00000X
TN4720235Z00000X
MSS3645235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135114721Medicaid