Individual
CARLY ANN CHEATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4450 N PROSPECT RD STE C5, PEORIA HEIGHTS, IL 61616-6578
(309) 363-7594
(309) 966-3621
Mailing address
1500 S MISSOURI AVE UNIT 3, MORTON, IL 61550-9028
(217) 706-0491
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
C350-1019-7862
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C350-1019-7862
STATE LICENSE
IL
Enumeration date
06/24/2022
Last updated
06/24/2022
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