Healthcare Provider Details

I. General information

NPI: 1134386402
Provider Name (Legal Business Name): MS. CHERYL SIDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 UNIVERSITY AVE STE 265
WEST DES MOINES IA
50266-8216
US

IV. Provider business mailing address

6800 LAKE DRIVE STE 250
WEST DES MOINES IA
50266-2504
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-9400
  • Fax: 515-875-9457
Mailing address:
  • Phone: 515-875-9178
  • Fax: 515-875-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number478
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: