Individual
CHERYL ANN CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.,CCC-SLP
Contact information
Practice address
305 MOORE AVE, LE ROY, IL 61752-1580
(309) 212-1567
(309) 962-6027
Mailing address
305 MOORE AVE, LE ROY, IL 61752-1580
(309) 212-1567
(309) 962-6027
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00732086
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/01/2006
Last updated
07/08/2007
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