Provider Demographics
NPI:1912335597
Name:MCILWAIN, CHERI LYN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:LYN
Last Name:MCILWAIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:CHERI
Other - Middle Name:LYN
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:335 FOUR MILE RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-4506
Mailing Address - Country:US
Mailing Address - Phone:843-488-6700
Mailing Address - Fax:843-488-6739
Practice Address - Street 1:335 FOUR MILE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4506
Practice Address - Country:US
Practice Address - Phone:843-488-6700
Practice Address - Fax:843-488-6739
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist