Provider Demographics
NPI:1083886063
Name:CUSTER, CHERYL (MED,CCC,SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:MED,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 MAHLER PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3312
Mailing Address - Country:US
Mailing Address - Phone:405-413-3397
Mailing Address - Fax:
Practice Address - Street 1:10020 MAHLER PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3312
Practice Address - Country:US
Practice Address - Phone:405-413-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist