Healthcare Provider Details

I. General information

NPI: 1336319425
Provider Name (Legal Business Name): DANIELLE E CHERUBIN MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W PARK ST
URBANA IL
61801-2500
US

IV. Provider business mailing address

2620 SE MARICAMP RD
OCALA FL
34471-5582
US

V. Phone/Fax

Practice location:
  • Phone: 217-326-2911
  • Fax: 217-344-8047
Mailing address:
  • Phone: 352-351-8883
  • Fax: 352-351-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA11408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: