Healthcare Provider Details

I. General information

NPI: 1952024945
Provider Name (Legal Business Name): JERYL HERRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 TAMIAMI TRL N STE B
NAPLES FL
34103-2853
US

IV. Provider business mailing address

7400 ESTERO BLVD APT 305
FORT MYERS BEACH FL
33931-4742
US

V. Phone/Fax

Practice location:
  • Phone: 239-351-4787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: