Provider Demographics
NPI:1154303378
Name:CHERRY, PEGGY RANDOLPH (M ED CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:RANDOLPH
Last Name:CHERRY
Suffix:
Gender:F
Credentials:M ED CCC SLP
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:RANDOLPH
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED CCC
Mailing Address - Street 1:25 LINNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2541
Mailing Address - Country:US
Mailing Address - Phone:281-265-7080
Mailing Address - Fax:
Practice Address - Street 1:25 LINNEY BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2541
Practice Address - Country:US
Practice Address - Phone:281-265-7080
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist