Provider Demographics
NPI:1336480417
Name:CHESTER COUNTY INTERMEDIATE
Entity Type:Organization
Organization Name:CHESTER COUNTY INTERMEDIATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-237-5275
Mailing Address - Street 1:455 BOOT RD
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3043
Mailing Address - Country:US
Mailing Address - Phone:484-237-5275
Mailing Address - Fax:
Practice Address - Street 1:455 BOOT RD
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3043
Practice Address - Country:US
Practice Address - Phone:484-237-5275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL0046311252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency