Provider Demographics
NPI:1962812289
Name:ROESSER, SHERYL
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:ROESSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 MURPHY BLVD
Mailing Address - Street 2:P.O. BOX 5758
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-6002
Mailing Address - Country:US
Mailing Address - Phone:770-535-8372
Mailing Address - Fax:770-535-0252
Practice Address - Street 1:2360 MURPHY BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-6002
Practice Address - Country:US
Practice Address - Phone:770-535-8372
Practice Address - Fax:770-535-0252
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist