Provider Demographics
NPI:1609292481
Name:LOCK, CHERYL ANN RAH (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN RAH
Last Name:LOCK
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 499
Mailing Address - Street 2:
Mailing Address - City:BABB
Mailing Address - State:MT
Mailing Address - Zip Code:59411
Mailing Address - Country:US
Mailing Address - Phone:406-845-8015
Mailing Address - Fax:
Practice Address - Street 1:3183 DUCK LAKE RD
Practice Address - Street 2:
Practice Address - City:BABB
Practice Address - State:MT
Practice Address - Zip Code:59411
Practice Address - Country:US
Practice Address - Phone:406-845-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-3056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist