Provider Demographics
NPI:1669030086
Name:CORDERMAN, CHEREE L
Entity Type:Individual
Prefix:
First Name:CHEREE
Middle Name:L
Last Name:CORDERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8162
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64508-8162
Mailing Address - Country:US
Mailing Address - Phone:816-390-8941
Mailing Address - Fax:816-617-1874
Practice Address - Street 1:1606 S 38TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2216
Practice Address - Country:US
Practice Address - Phone:816-390-8941
Practice Address - Fax:816-279-7728
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities