Provider Demographics
NPI:1245410364
Name:CAIN, CHERYL LYNNE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNNE
Last Name:CAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8811
Mailing Address - Country:US
Mailing Address - Phone:304-267-3565
Mailing Address - Fax:304-264-5059
Practice Address - Street 1:2000 TAVERN RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8811
Practice Address - Country:US
Practice Address - Phone:304-267-3565
Practice Address - Fax:304-264-5059
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0153186000Medicaid