Provider Demographics
NPI:1164767331
Name:SMITH, CHERI LYNN (MHS-CCC SLP)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MHS-CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MESSINA DR
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1473
Mailing Address - Country:US
Mailing Address - Phone:773-512-1138
Mailing Address - Fax:
Practice Address - Street 1:3100 MESSINA DR
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1473
Practice Address - Country:US
Practice Address - Phone:773-512-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist