Provider Demographics
NPI:1053710103
Name:SIMMONS CHIN, CHERELLE RENEE (SLPD CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:CHERELLE
Middle Name:RENEE
Last Name:SIMMONS CHIN
Suffix:
Gender:F
Credentials:SLPD CCC-SLP
Other - Prefix:DR
Other - First Name:CHERELLE
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPD CCC-SLP
Mailing Address - Street 1:3509 32ND ST SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-4367
Mailing Address - Country:US
Mailing Address - Phone:215-678-9867
Mailing Address - Fax:
Practice Address - Street 1:3509 32ND ST SW
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-4367
Practice Address - Country:US
Practice Address - Phone:215-678-9867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105983200Medicaid