Provider Demographics
NPI:1891813598
Name:KISH, CHERIE (HIS)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:KISH
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MAIN ST STE 21
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-3636
Mailing Address - Country:US
Mailing Address - Phone:508-824-4327
Mailing Address - Fax:774-213-9646
Practice Address - Street 1:54 MAIN ST STE 21
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-3636
Practice Address - Country:US
Practice Address - Phone:508-824-4327
Practice Address - Fax:774-213-9646
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA62668164W00000X
MA291237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0704521Medicaid