Provider Demographics
NPI:1265943278
Name:DOEDEN, CHERYL ANN (MHS,CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:DOEDEN
Suffix:
Gender:F
Credentials:MHS,CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10913 S OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-1522
Mailing Address - Country:US
Mailing Address - Phone:708-203-1304
Mailing Address - Fax:
Practice Address - Street 1:10800 LYMAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2250
Practice Address - Country:US
Practice Address - Phone:708-636-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146.011304Medicaid