Basic Information
| Provider Information | |||||||||
| NPI: | 1215987680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | CHERI | ||||||||
| MiddleName: | BROOKS | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 884 LOBLOLLY DR | ||||||||
| Address2: | |||||||||
| City: | VASS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283948124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102453045 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 RAMSEY ST | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283013856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108227983 | ||||||||
| FaxNumber: | 9108227088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 6626 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.