Provider Demographics
NPI:1295909059
Name:CHURCHILL, CHERYL MARIE I
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:CHURCHILL
Suffix:I
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 1:15592 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-6406
Mailing Address - Country:US
Mailing Address - Phone:715-934-3116
Mailing Address - Fax:
Practice Address - Street 1:15592 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6406
Practice Address - Country:US
Practice Address - Phone:715-934-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1812-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist