Provider Demographics
NPI:1659694198
Name:WESSEL, CHERYL BRENNER (SLP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:BRENNER
Last Name:WESSEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:BRENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2520 RAMBLING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-7805
Mailing Address - Country:US
Mailing Address - Phone:919-880-7946
Mailing Address - Fax:
Practice Address - Street 1:2520 RAMBLING CREEK RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-7805
Practice Address - Country:US
Practice Address - Phone:919-880-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1659694198Medicaid