Provider Demographics
NPI:1073020178
Name:GILLILAND, CHERYL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:GILLILAND
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 1:1009 TOTEM TRL
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-9296
Mailing Address - Country:US
Mailing Address - Phone:815-385-1223
Mailing Address - Fax:
Practice Address - Street 1:1011 N GREEN ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5720
Practice Address - Country:US
Practice Address - Phone:815-344-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist