Provider Demographics
NPI:1043357494
Name:CHEEKS, BEVERLY (SLP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:CHEEKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 HONEYSUCKLE BEND DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6844
Mailing Address - Country:US
Mailing Address - Phone:919-946-3820
Mailing Address - Fax:
Practice Address - Street 1:7805 HONEYSUCKLE BEND DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-6844
Practice Address - Country:US
Practice Address - Phone:919-946-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6705235Z00000X
FLSA 14089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411148Medicaid
NC1078ROtherBCBS