Provider Demographics
NPI:1720373640
Name:DOUGLAS, CHERYL DENISE (SLP-CCC/L)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:DENISE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:SLP-CCC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10438 S MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-3090
Mailing Address - Country:US
Mailing Address - Phone:773-552-1670
Mailing Address - Fax:
Practice Address - Street 1:10438 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3090
Practice Address - Country:US
Practice Address - Phone:773-552-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist