Provider Demographics
NPI:1902325624
Name:SOUTHARD, SCHERYIAH J (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SCHERYIAH
Middle Name:J
Last Name:SOUTHARD
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 1572
Mailing Address - Street 2:
Mailing Address - City:CAPITAN
Mailing Address - State:NM
Mailing Address - Zip Code:88316-1572
Mailing Address - Country:US
Mailing Address - Phone:575-973-8220
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 278
Practice Address - Street 2:
Practice Address - City:CAPITAN
Practice Address - State:NM
Practice Address - Zip Code:88316-0278
Practice Address - Country:US
Practice Address - Phone:575-354-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist