Provider Demographics
NPI:1700217627
Name:PHILLIPS, CHERMIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHERMIA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 MILL VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3768
Mailing Address - Country:US
Mailing Address - Phone:252-565-9158
Mailing Address - Fax:
Practice Address - Street 1:4519 MILL VILLAGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3768
Practice Address - Country:US
Practice Address - Phone:252-565-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10040235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist