Healthcare Provider Details

I. General information

NPI: 1952880239
Provider Name (Legal Business Name): STEPHANIE ELYSE CHERRY MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 33RD ST
BALTIMORE MD
21218-3780
US

IV. Provider business mailing address

7103 PHEASANT CROSS DR
BALTIMORE MD
21209-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-9890
  • Fax:
Mailing address:
  • Phone: 410-960-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number05298
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: