Provider Demographics
NPI:1376509216
Name:RUNGE, CHERYL A (MS,CCC-A)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:RUNGE
Suffix:
Gender:F
Credentials:MS,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 E INDIAN SCHOOL RD
Mailing Address - Street 2:#120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6889
Mailing Address - Country:US
Mailing Address - Phone:602-224-5970
Mailing Address - Fax:602-224-5981
Practice Address - Street 1:3104 E INDIAN SCHOOL RD
Practice Address - Street 2:#120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6889
Practice Address - Country:US
Practice Address - Phone:602-224-5970
Practice Address - Fax:602-224-5981
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ695231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR03039Medicare UPIN