Provider Demographics
NPI:1992812697
Name:BRONECK, CHERYL LYNN (PHD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:BRONECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-0340
Mailing Address - Country:US
Mailing Address - Phone:618-474-6240
Mailing Address - Fax:618-474-6242
Practice Address - Street 1:915 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6434
Practice Address - Country:US
Practice Address - Phone:618-463-5442
Practice Address - Fax:618-474-6242
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
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