Provider Demographics
NPI:1508207655
Name:NELSON, CHERYL R (MA, MED, MS)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA, MED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 W END DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2232
Mailing Address - Country:US
Mailing Address - Phone:215-869-0533
Mailing Address - Fax:
Practice Address - Street 1:1445 W END DR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2232
Practice Address - Country:US
Practice Address - Phone:215-869-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist