Provider Demographics
NPI:1003390071
Name:STUBBS, CHERYL A (CCC SLP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:STUBBS
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 1:410 OLDE POST RD
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3906
Mailing Address - Country:US
Mailing Address - Phone:850-797-3605
Mailing Address - Fax:
Practice Address - Street 1:410 OLDE POST RD
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3906
Practice Address - Country:US
Practice Address - Phone:850-797-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist