Provider Demographics
NPI:1972774669
Name:PICKETT, SHERRY KAY (AUD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:KAY
Last Name:PICKETT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:KAY
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:10900 MANCHESTER ROAD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122
Mailing Address - Country:US
Mailing Address - Phone:314-835-9996
Mailing Address - Fax:314-835-9992
Practice Address - Street 1:10900 MANCHESTER ROAD
Practice Address - Street 2:SUITE #202
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122
Practice Address - Country:US
Practice Address - Phone:314-835-9996
Practice Address - Fax:314-835-9992
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112236231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO138830005Medicare PIN