Provider Demographics
NPI:1265714216
Name:HOOSOCK, CHERYL L (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:L
Last Name:HOOSOCK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 E. SENECA TRPK
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078
Mailing Address - Country:US
Mailing Address - Phone:315-445-8460
Mailing Address - Fax:
Practice Address - Street 1:6409 E SENECA TPKE
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-9506
Practice Address - Country:US
Practice Address - Phone:315-445-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013290-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist