Provider Demographics
NPI:1619236155
Name:PELKA, CHERYL MARIA (MED,LSW,PCC-S)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIA
Last Name:PELKA
Suffix:
Gender:F
Credentials:MED,LSW,PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2040
Mailing Address - Country:US
Mailing Address - Phone:440-260-8366
Mailing Address - Fax:440-260-8390
Practice Address - Street 1:303 E BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2040
Practice Address - Country:US
Practice Address - Phone:440-260-8366
Practice Address - Fax:440-260-8390
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional