Provider Demographics
NPI:1497053185
Name:CHERRIE, MARGO
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:CHERRIE
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 1:2210 BLACKSMITH DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-8974
Mailing Address - Country:US
Mailing Address - Phone:630-276-6180
Mailing Address - Fax:
Practice Address - Street 1:2210 BLACKSMITH DR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-8974
Practice Address - Country:US
Practice Address - Phone:630-276-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC600-5458-9678103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst