Provider Demographics
NPI:1932709953
Name:CHERNOV, LERA A (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LERA
Middle Name:A
Last Name:CHERNOV
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 1:4243 BONITA RD APT 60
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1441
Mailing Address - Country:US
Mailing Address - Phone:646-724-3332
Mailing Address - Fax:
Practice Address - Street 1:4243 BONITA RD APT 60
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1441
Practice Address - Country:US
Practice Address - Phone:646-724-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist