Provider Demographics
NPI:1093063455
Name:HAWLEY, CHERYL DIANNE (MA/CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DIANNE
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:MA/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 GREENSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7681
Mailing Address - Country:US
Mailing Address - Phone:769-572-5506
Mailing Address - Fax:
Practice Address - Street 1:4500 I 55 N
Practice Address - Street 2:HIGHLAND VILLAGE STE 291
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5930
Practice Address - Country:US
Practice Address - Phone:601-362-0859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist