Provider Demographics
NPI:1487049615
Name:CROOM, CHERYL (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:CROOM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 WING TIP CIR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8721
Mailing Address - Country:US
Mailing Address - Phone:270-885-8198
Mailing Address - Fax:
Practice Address - Street 1:1910 S VIRGINIA ST STE 200
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-6009
Practice Address - Country:US
Practice Address - Phone:270-707-3454
Practice Address - Fax:270-889-9911
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist