Provider Demographics
NPI:1427469246
Name:TUCKER, CHERYL (MACCCSLP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 MATTHEWS MINT HILL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-6514
Mailing Address - Country:US
Mailing Address - Phone:980-237-6226
Mailing Address - Fax:980-237-6288
Practice Address - Street 1:7900 MATTHEWS MINT HILL RD STE 115
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-6514
Practice Address - Country:US
Practice Address - Phone:980-237-6226
Practice Address - Fax:980-237-6288
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist