Provider Demographics
NPI:1043515711
Name:PHILLIPS, CHERRY T (LLHIS)
Entity Type:Individual
Prefix:MRS
First Name:CHERRY
Middle Name:T
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LLHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HUDSON LN
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6045
Mailing Address - Country:US
Mailing Address - Phone:318-325-2363
Mailing Address - Fax:318-325-2361
Practice Address - Street 1:1101 HUDSON LN
Practice Address - Street 2:SUITE 1-C
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6045
Practice Address - Country:US
Practice Address - Phone:318-325-2363
Practice Address - Fax:318-325-2361
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA680237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist