Provider Demographics
NPI:1922316033
Name:WEYMOUTH, CHERELLE J
Entity Type:Individual
Prefix:
First Name:CHERELLE
Middle Name:J
Last Name:WEYMOUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-6096
Mailing Address - Country:US
Mailing Address - Phone:207-835-1216
Mailing Address - Fax:
Practice Address - Street 1:149 FRONT ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530
Practice Address - Country:US
Practice Address - Phone:207-443-3341
Practice Address - Fax:207-443-1070
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist