Provider Demographics
NPI:1558535534
Name:CHERRY, JAY DEAN (MA, CCC/A)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:DEAN
Last Name:CHERRY
Suffix:
Gender:M
Credentials:MA, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-1428
Mailing Address - Country:US
Mailing Address - Phone:812-523-3323
Mailing Address - Fax:812-523-3323
Practice Address - Street 1:822 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-1428
Practice Address - Country:US
Practice Address - Phone:812-523-3323
Practice Address - Fax:812-523-3323
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002133231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist