Provider Demographics
NPI:1851550669
Name:GOWLIS, CHERYL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GOWLIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:KONOPKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:27 DEPOT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2601
Mailing Address - Country:US
Mailing Address - Phone:860-274-3200
Mailing Address - Fax:860-274-8100
Practice Address - Street 1:27 DEPOT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2601
Practice Address - Country:US
Practice Address - Phone:860-274-3200
Practice Address - Fax:860-274-8100
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist