Provider Demographics
NPI:1245201359
Name:HETHERINGTON, CHERYL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N LINN ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2143
Mailing Address - Country:US
Mailing Address - Phone:319-337-9461
Mailing Address - Fax:319-339-8061
Practice Address - Street 1:123 N LINN ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2143
Practice Address - Country:US
Practice Address - Phone:319-337-9461
Practice Address - Fax:319-339-8061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA486103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA68009314OtherRR MEDICARE
IA322OtherHEALTH SERVICE PROVIDER
IA52714OtherWELLMARK PROVIDER NUMBER
IA322OtherHEALTH SERVICE PROVIDER