Provider Demographics
NPI:1104312115
Name:WYCKOFF, CHERICE LYNN (SLP)
Entity type:Individual
Prefix:
First Name:CHERICE
Middle Name:LYNN
Last Name:WYCKOFF
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 NUECES TRL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5555
Mailing Address - Country:US
Mailing Address - Phone:817-789-3292
Mailing Address - Fax:
Practice Address - Street 1:848 NUECES TRL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5555
Practice Address - Country:US
Practice Address - Phone:817-789-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist