Provider Demographics
NPI:1649904061
Name:HOLLISTER, SHERRI KAE (CF-SLP)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:KAE
Last Name:HOLLISTER
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10180 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7207
Mailing Address - Country:US
Mailing Address - Phone:612-747-6579
Mailing Address - Fax:
Practice Address - Street 1:10180 VIKING DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7207
Practice Address - Country:US
Practice Address - Phone:612-747-6579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN518253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist