Provider Demographics
NPI:1457588451
Name:MCDANIEL, CHERYL M (MED,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:M
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CHAMPAGNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-3700
Mailing Address - Country:US
Mailing Address - Phone:337-507-1106
Mailing Address - Fax:337-332-3582
Practice Address - Street 1:210 CHAMPAGNE BLVD
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3700
Practice Address - Country:US
Practice Address - Phone:337-507-1106
Practice Address - Fax:337-332-3582
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist