Provider Demographics
NPI:1053622076
Name:PREDMORE, CHERYL SUZANNE (MS CCC/SLP-L)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:SUZANNE
Last Name:PREDMORE
Suffix:
Gender:F
Credentials:MS CCC/SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28032 STONY POINT RD
Mailing Address - Street 2:
Mailing Address - City:CAPE VINCENT
Mailing Address - State:NY
Mailing Address - Zip Code:13618-3140
Mailing Address - Country:US
Mailing Address - Phone:585-732-7348
Mailing Address - Fax:
Practice Address - Street 1:28032 STONY POINT RD
Practice Address - Street 2:
Practice Address - City:CAPE VINCENT
Practice Address - State:NY
Practice Address - Zip Code:13618-3140
Practice Address - Country:US
Practice Address - Phone:585-732-7348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015793-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist