Provider Demographics
NPI:1356554505
Name:ANDERSON, CHERYL C (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:C
Last Name:ANDERSON
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 1:30031 TROUTDALE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7734
Mailing Address - Country:US
Mailing Address - Phone:303-670-3268
Mailing Address - Fax:303-679-0233
Practice Address - Street 1:30772 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2213
Practice Address - Country:US
Practice Address - Phone:303-670-3268
Practice Address - Fax:303-679-0233
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00371823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist