Provider Demographics
NPI:1902216674
Name:COTRELL, SHERIDAN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERIDAN
Middle Name:
Last Name:COTRELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 BLUE STEM PL
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-4779
Mailing Address - Country:US
Mailing Address - Phone:406-670-3680
Mailing Address - Fax:
Practice Address - Street 1:21 LOCH LOMOND RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-8837
Practice Address - Country:US
Practice Address - Phone:406-223-6763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist