Provider Demographics
NPI:1184715989
Name:KINNEY, CHERYL A (AUD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:A
Last Name:KINNEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:BONERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:512 WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1254
Mailing Address - Country:US
Mailing Address - Phone:920-563-6667
Mailing Address - Fax:920-563-0145
Practice Address - Street 1:512 WILCOX ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1254
Practice Address - Country:US
Practice Address - Phone:920-563-6667
Practice Address - Fax:920-563-0145
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71-156237600000X
WI237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41120800Medicaid
WI71-156OtherSTATE
WI71-156OtherSTATE
WIWI2787003Medicare PIN