Provider Demographics
NPI:1134282841
Name:BRACKIN, CHERYL ANN (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:BRACKIN
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 1:1206 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5704
Mailing Address - Country:US
Mailing Address - Phone:912-355-4601
Mailing Address - Fax:912-355-7935
Practice Address - Street 1:1206 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5704
Practice Address - Country:US
Practice Address - Phone:912-355-4601
Practice Address - Fax:912-355-7935
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist