Provider Demographics
NPI:1174742696
Name:MAINS, SHERYL LYNN (MSCCCSLP)
Entity type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:LYNN
Last Name:MAINS
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:MISS
Other - First Name:SHERYL
Other - Middle Name:LYNN
Other - Last Name:HARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1144 DRY DAM RD
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-4513
Mailing Address - Country:US
Mailing Address - Phone:724-527-3669
Mailing Address - Fax:
Practice Address - Street 1:316 DONOHOE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6988
Practice Address - Country:US
Practice Address - Phone:724-837-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000974L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019021070005Medicaid