Provider Demographics
NPI:1063562452
Name:CHERULLO, ERNEST ALFRED III (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:ALFRED
Last Name:CHERULLO
Suffix:III
Gender:M
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W 104TH ST APT 101A
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6220
Mailing Address - Country:US
Mailing Address - Phone:773-860-9465
Mailing Address - Fax:
Practice Address - Street 1:3617 N TRIPP AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3038
Practice Address - Country:US
Practice Address - Phone:773-727-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist