Provider Demographics
NPI:1992075154
Name:CONVERSE, SHERRY LOU
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LOU
Last Name:CONVERSE
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 1:142 W CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-1320
Mailing Address - Country:US
Mailing Address - Phone:315-521-3952
Mailing Address - Fax:
Practice Address - Street 1:1150 S. WINTON RD.
Practice Address - Street 2:BRIGTON HIGH SCHOOL
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-242-5000
Practice Address - Fax:585-242-7364
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist