Provider Demographics
NPI:1376087049
Name:IWANOWSKI, CHERYL
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:IWANOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 TURNBERRY RD
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-6818
Mailing Address - Country:US
Mailing Address - Phone:412-337-3730
Mailing Address - Fax:
Practice Address - Street 1:443 TURNBERRY RD
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-6818
Practice Address - Country:US
Practice Address - Phone:412-337-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist