Provider Demographics
NPI:1699889089
Name:SCALLON, CHERYL (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:SCALLON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9631 W 153RD ST
Mailing Address - Street 2:#38
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3774
Mailing Address - Country:US
Mailing Address - Phone:708-460-0235
Mailing Address - Fax:305-425-0235
Practice Address - Street 1:9631 W 153RD ST
Practice Address - Street 2:#38
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3774
Practice Address - Country:US
Practice Address - Phone:708-460-0235
Practice Address - Fax:305-425-0235
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
201231Medicare ID - Type Unspecified