Provider Demographics
NPI:1104908920
Name:BRANSCUM, CHERYL ANNETTE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANNETTE
Last Name:BRANSCUM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8839 BAINBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8331
Mailing Address - Country:US
Mailing Address - Phone:501-733-5270
Mailing Address - Fax:
Practice Address - Street 1:2115 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4149
Practice Address - Country:US
Practice Address - Phone:251-937-2823
Practice Address - Fax:251-937-2821
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1342235Z00000X
AL3661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141346721Medicaid
AR5V273Medicare PIN