Provider Demographics
NPI:1851837868
Name:LODGE, CHERYL F (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:F
Last Name:LODGE
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 S HAIRPIN DR
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-1512
Mailing Address - Country:US
Mailing Address - Phone:937-572-5649
Mailing Address - Fax:
Practice Address - Street 1:10049 COURTHOUSE RD # RE
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:VA
Practice Address - Zip Code:23030-3440
Practice Address - Country:US
Practice Address - Phone:804-829-9256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist