Provider Demographics
NPI:1982442240
Name:MCCLENDON, CHERYL MARIE (LMT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:MARIE
Other - Last Name:TIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:230 S MAIN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1625
Mailing Address - Country:US
Mailing Address - Phone:414-736-1136
Mailing Address - Fax:
Practice Address - Street 1:230 S MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-1625
Practice Address - Country:US
Practice Address - Phone:414-736-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15137-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty