Provider Demographics
NPI:1811753650
Name:CERICOLA, CHERYL LAUREN (SLP-TEMPORARY)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LAUREN
Last Name:CERICOLA
Suffix:
Gender:F
Credentials:SLP-TEMPORARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 N 30TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5010
Mailing Address - Country:US
Mailing Address - Phone:497-021-4489
Mailing Address - Fax:
Practice Address - Street 1:3421 E CONSTANCE WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-0012
Practice Address - Country:US
Practice Address - Phone:856-816-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA144602355S0801X
AZTSLP14460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant