Provider Demographics
NPI:1649479601
Name:GLIESCHE, SHERRY T (MA,MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:T
Last Name:GLIESCHE
Suffix:
Gender:F
Credentials:MA,MS, 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:PO BOX 357742
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7742
Mailing Address - Country:US
Mailing Address - Phone:352-284-4948
Mailing Address - Fax:352-466-1045
Practice Address - Street 1:8800 NW 230TH ST
Practice Address - Street 2:
Practice Address - City:MICANOPY
Practice Address - State:FL
Practice Address - Zip Code:32667-7476
Practice Address - Country:US
Practice Address - Phone:352-284-4948
Practice Address - Fax:352-466-1045
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist