Provider Demographics
NPI:1275823759
Name:SHEEHAN, CHARLENE COX (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:COX
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 GREYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-8641
Mailing Address - Country:US
Mailing Address - Phone:270-350-0575
Mailing Address - Fax:
Practice Address - Street 1:334 GREYSTONE LN
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-8641
Practice Address - Country:US
Practice Address - Phone:270-350-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist