Provider Demographics
NPI:1710548938
Name:THOMAS, CHERYL (MS, CGC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 13TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1810
Mailing Address - Country:US
Mailing Address - Phone:507-269-8854
Mailing Address - Fax:
Practice Address - Street 1:877 EXECUTIVE CENTER DR W STE 206
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2472
Practice Address - Country:US
Practice Address - Phone:760-407-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1116170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS