Provider Demographics
NPI:1366706566
Name:SPEECH AND SWALLOWING REHABILITATION, PC
Entity type:Organization
Organization Name:SPEECH AND SWALLOWING REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERMETRA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:DELAINE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC, SLP
Authorized Official - Phone:256-684-2124
Mailing Address - Street 1:302 HARBOR GLEN DR SW
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-2812
Mailing Address - Country:US
Mailing Address - Phone:256-684-2114
Mailing Address - Fax:256-464-9243
Practice Address - Street 1:7027 OLD MADISON PIKE NW
Practice Address - Street 2:SUITE 108
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2368
Practice Address - Country:US
Practice Address - Phone:256-684-2124
Practice Address - Fax:256-464-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty