Provider Demographics
NPI:1831365790
Name:OATES, SHERRILL DIANE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHERRILL
Middle Name:DIANE
Last Name:OATES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SPICE OAK LN
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3253
Mailing Address - Country:US
Mailing Address - Phone:210-867-8279
Mailing Address - Fax:210-566-5626
Practice Address - Street 1:6655 FIRST PARK TEN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4304
Practice Address - Country:US
Practice Address - Phone:210-737-8090
Practice Address - Fax:210-733-0841
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist