Provider Demographics
NPI:1306064647
Name:GAULT, SHERI HARRIS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:HARRIS
Last Name:GAULT
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 1:3511 FOUNTAINBLEAU RD
Mailing Address - Street 2:
Mailing Address - City:KEITHVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71047-8546
Mailing Address - Country:US
Mailing Address - Phone:318-218-7656
Mailing Address - Fax:
Practice Address - Street 1:3511 FOUNTAINBLEAU RD
Practice Address - Street 2:
Practice Address - City:KEITHVILLE
Practice Address - State:LA
Practice Address - Zip Code:71047-8546
Practice Address - Country:US
Practice Address - Phone:318-218-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1472174Medicaid