MEDICARE: MRS. CHERYL A NICHOLS M.A.T., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	22001998A	IN

General Provider Information

NPI Number	:	1588834162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL A NICHOLS M.A.T., CCC-SLP

Provider Business Mailing Address
First Line	:	10314 RIVER RAPIDS RUN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-8949
Country	:	US
Telephone Number	:	260-760-3724
Fax Number	:

Provider Business Practice Location Address
First Line	:	10314 RIVER RAPIDS RUN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-8949
Country	:	US
Telephone Number	:	260-760-3724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	03/10/2008

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Directions to “ MRS. CHERYL A NICHOLS M.A.T., CCC-SLP” Practice Location

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