Provider Demographics
NPI:1376070268
Name:THOMAS, CHERISH ANNIE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHERISH
Middle Name:ANNIE
Last Name:THOMAS
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 1:613 CORTLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2366
Mailing Address - Country:US
Mailing Address - Phone:414-881-7390
Mailing Address - Fax:
Practice Address - Street 1:1161 MCHENRY RD STE 201
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1373
Practice Address - Country:US
Practice Address - Phone:847-383-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist