Provider Demographics
NPI:1346515392
Name:CHEEK, ELIZABETH DIANN (M ED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANN
Last Name:CHEEK
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BEACH DR W
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-4113
Mailing Address - Country:US
Mailing Address - Phone:478-230-7069
Mailing Address - Fax:
Practice Address - Street 1:80 BEACH DR W
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-4113
Practice Address - Country:US
Practice Address - Phone:478-230-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007489235Z00000X
FLSA 11246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist