Provider Demographics
NPI:1326415928
Name:FRY, CHERI (MA, CCC-SP)
Entity Type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10875 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6068
Mailing Address - Country:US
Mailing Address - Phone:225-667-6622
Mailing Address - Fax:225-667-2084
Practice Address - Street 1:10875 BROWN RD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-6068
Practice Address - Country:US
Practice Address - Phone:225-667-6622
Practice Address - Fax:225-667-2084
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist