Provider Demographics
NPI:1003834730
Name:GIPSON, CHERYL (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:GIPSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:IL
Mailing Address - Zip Code:61423-0156
Mailing Address - Country:US
Mailing Address - Phone:309-333-7954
Mailing Address - Fax:
Practice Address - Street 1:548 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:IL
Practice Address - Zip Code:61423-0156
Practice Address - Country:US
Practice Address - Phone:309-333-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist